Feasibility, Acceptability, and Preliminary Phase II Efficacy Testing of a Community-Informed Infant Obesity Prevention Program Addressing the Impact of Maternal Mental Health on Eating and Feeding - Poor dietary habits and obesity risk begin early in infancy. Infants from families with low incomes experience disparate rates of poor nutritional outcomes and subsequent negative health outcomes related to obesity, and food insecurity and maternal mental health are barriers to healthy eating that may play an increased role for low-income families. However, obesity prevention programs that meet the needs of low-income families and address the key obesogenic factor of the impact of maternal mental health on eating and feeding are lacking. Our team developed an obesity prevention program, Healthy Eating for My Infant (HEMI), to address the unique factors influencing obesity risk and health behaviors among low-income families and their infants and to be delivered in conjunction with an existing evidence-based home visiting program. HEMI was developed through an iterative and collaborative process with community members (e.g., families, home visitors), including a community needs assessment and program modification following initial feasibility and acceptability testing feedback from families, implementers of the program, and a community advisory board (R21NR019126). HEMI targets healthy feeding with children 3-14 months old through twice monthly behavioral and educational sessions alongside sessions with a peer counselor with similar lived experience to mothers in the program. HEMI incorporates education and evidence-based behavioral techniques (e.g., problem solving, goal setting, behavioral rehearsal) to address topics such as infant nutrition, introduction of solid foods, responsive feeding, realistic healthy eating options, healthy eating on a budget, and recipes). Sessions utilize a trauma-informed approach, evidence-based behavioral change techniques, and explicitly address maternal mental health. Additionally, HEMI addresses food access through grocery delivery, supplemental food, and work with a peer counselor regarding realistic recommendations and modeling of grocery shopping and meal planning. This study will examine feasibility, acceptability, and preliminary efficacy of HEMI with 60 infants and their families randomized to either the program or a control condition (i.e., standard home visiting services only). Aim 1 will examine the feasibility and acceptability of implementation of HEMI by assessing retention, treatment completion rates, feasibility and acceptability as perceived by program interventionists, and acceptability to families using the theoretical framework of acceptability. Aim 2 will test HEMI’s efficacy in impacting infant growth trajectories, diet, and food security at post-treatment and 6-month follow-up. Aim 3 will investigate the program’s impact on maternal feeding self-efficacy, social support, responsive feeding style, parenting stress, and depressive symptoms, including whether maternal factors mediate the program’s impact on infant growth and diet. Results of this Phase II testing will inform a large Phase III clinical trial to examine efficacy of HEMI for obesity prevention and moderators and mediators of program efficacy.
