An exploration of infant feeding practicesAn exploration of infant feeding practices and barriers faced by health professionals delivering feeding advice to the Roma

Ada L Garcia Uloma Onuoha Alison Parrett and

delivering feeding advice  to the Roma population in South GlasgowAda L. Garcia, Uloma Onuoha, Alison Parrett  and Lesleyann Currie

Human Nutrition, MVLS, University of Glasgow.NHS Health Improvement Team, South Sector,Glasgow City Health and Social Care Partnership. 

BackgroundRoma travellers are the largest and most diverse ethnic group in Europe with settlements in Romania, Serbia, Slovakia, Hungary, Czech Republic

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with settlements in Romania, Serbia, Slovakia, Hungary, Czech Republic and the UK (Kosa & Adany, 2007).

Roma travelling communities have a long tradition of mobility due toRoma travelling communities have a long tradition of mobility due to “push” and “pull” factors. • Push factors: discrimination, racism and high level of unemployment.• Pull factors: education job opportunities tolerance lack of trust in the system• Pull factors: education, job opportunities, tolerance, lack of trust in the system.

In Roma communities social exclusion is associated with poorer health status higher mortality rates and lower life expectancy when compared tostatus, higher mortality rates and lower life expectancy when compared to other ethnic minorities or their white UK counterparts who socioeconomically face deprivation (Van Cleemput, 2010).

Glasgow (mainly Govanhill) has a settlement of around 25% of total Roma population in Scotland in 2013.

Backgroundg

Roma gypsies and travellers have been termed a “hard to reach” group b h lth titi (HP) (S ith & R t 2013)by health practitioners (HP) (Smith & Ruston, 2013).

HP working with Roma communities in Glasgow City Health and Social Care Partnership (HSCP) south locality expressed pressing challenges to promote their health, areas of concerned in early years health were:• Use of cow’s milk• Uncertain about breast feeding advice• Lack of suitable resources for health promotion due to language

limitations and cultural barriers (increased “outreach” care) .limitations and cultural barriers (increased outreach care) .

Gaining insight into the opinions of mothers of Roma origin and HPs working with the Roma group would be of utmost importance to gettingworking with the Roma group would be of utmost importance to getting vital information to improve the health practices of this group.

R h iResearch questions

1. What are the opinions and views of Roma mothers living in Glasgow on infant feeding practices?

2 What are the perceptions of Roma mothers on the support2. What are the perceptions of Roma mothers on the support received from Health Professionals in relation to infant feeding in Glasgow?

3 Wh t d th thi k f t i f i t i l f3. What do they think of two versions of a pictorial resource for health promotion?

3. What are the challenges/barriers faced by Health g yProfessionals in Scotland during Health care delivery to the Roma community?

Topic guide – mothers/careers

1. What did you feed your baby when he/she was born?

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2. Why did you choose breast of formula?3. What do you think about giving your baby cow’s milk?

Prompt: age reason to introduce cow’s milkPrompt: age, reason to introduce cow s milk 4. How long have you been living in UK/Glasgow?5. How different is feeding babies here in Scotland compared to your own culture?6 Did t f il f i d i d i h t t f d b b ?6. Did your partner, family or friends give you advice on what to feed your baby?7. Who else has given you advice on how to feed your baby?8. Was this advice useful?9. What would be helpful in supporting you with feeding your baby?10. What do you think about the printed information about formula feeding?11 What could the Health visitor do differently to support you with feeding your11. What could the Health visitor do differently to support you with feeding your

baby?

Sample characteristicsSample characteristics

F 5 4 i G hill H l h C d 1 i D i Ch i• Focus groups = 5; 4 in Govanhill Health Centre and 1 in Daisy Chain• Interviews = 3; 2 in HC and 1 in Daisy Chain• A total of 25 participants (13 in HC and 12 in Daisy Chain)A total of 25 participants (13 in HC and 12 in Daisy Chain) • Nationalities: 5 (20%) from Slovakia and 20 (80%) from Rumania.• Age (mean ± SD): 26 ± 6y; min-max: 18-39 • Number of years living in Scotland (median): 2y, min-max :2-48 • Number of children (median): 2, min-max: 1-8

Results from FG & interviewsFeeding practicesBreastfeeding/bottle feeding• Most of mothers reported to have BF (87%) their infants and were confident aboutMost of mothers reported to have BF (87%) their infants and were confident about

their choice. • Reasons for feeding choice:

• Mum: “It’s the healthiest milk”• Mum: “it’s better for our children than formula. Sometimes when my daughter

get a bit like fever, I don’t give her medicine I just rather give her the breast or even like high temperature, with the breast it’s better”.

• One mother said: “Didn’t have any breast milk therefore went for bottle.”

Use of cow’s milk• Most do not use cow’s milk. • Reasons for not giving cow’s milk:

Mum: “……..Hmmm as long as I have still breast (milk), I won’t, I don’t think it’s better than my own”.Mum: “… Never entertained the idea”Mum: “Cow’s milk doesn’t have as much nutrition as breast” Mum: “It’s just ehmm for example my child is allergic to cow’s milk”

Results from FG & interviewsResults from FG & interviewsFeeding practicesUse of cow’s milk• Few (3) responses indicated “it is ok to give cow’s milk” .Reasons for giving cow’s milk

“…breast milk was not enough” (a mother who said giving cow’s milk at 6…breast milk was not enough (a mother who said giving cow s milk at 6 weeks)

Time to introduce cow’s milk• Most mothers said the age to introduce cow’s milk >1 yg y

Living in GlasgowIt was apparent that those living longer in the UK are well aware of the breastfeeding t as appa e t t at t ose g o ge t e U a e e a a e o t e b east eed gmessages.

Mum: “We’ve been taught that it (breast milk) contains a lot of vitamins, it’s better than (cow’s milk), that’s why we think just breastfeed our babies”.

Results from FG & interviewsFeeding practices in Scotland vs own country• Most mothers indicated that feeding practices are the same. However, one mum speaks of g p , p

better quality foods being more available in home country than in the UK.“I think at home it’s a better quality produced foods than here, it feeds children better”.Also one mum said “Most Scottish mothers give formula rather than breastfeed, in home country some breastfeed and some give formula”

Sources of advice/usefulness • Parents, grandparents and parents-in-law offered advice on how to feed baby • Participants were satisfied with the advice of HV/HP

Mum: “Yes the nurses, the midwives, health visitor, Anne-Marie, Tracy…. they come to our home or when I come here they teach us a lot of things”.Mum: “I think it’s enough what they say, I don't’ know exactly what else they h ld t ll ”should tell us more”.

Mum: “For example when I just gave birth I didn’t know a lot of stuff, the health visitor came to show me how to keep the baby, how to put the baby to breast even now every time she teach me things you know”breast, even now every time she teach me things you know .

Choice 1 of pictorial aid for development of resource

Choice 2 of pictorial aid for development of resource

Topic Guide for Health Practitioners pPerceived barriers to engage with

Roma groups

1. What are your experiences engaging with Roma families?2. What type of teaching resources do you use?2. What type of teaching resources do you use?3. What are the barriers you have experienced while

delivering Health Promotion/Nutrition Education related to infant feeding/ Breastfeeding and complementaryinfant feeding/ Breastfeeding and complementary feeding?

4. What do you do when you encounter some of these barriers?barriers?

5. Are there suggestions of other resources or other means of engaging or improving engagement with this group

Results from interviews with HP(n=3)

Barriers experienced while delivering Health promotion/ Nutrition education related to infant feeding( BF & CF)?

• Uptake of services could be variable/low. Difficulties to determine reasons for lack of attendancereasons for lack of attendance.

• Cultural barriers.• Language barriers/Time lag in translating resources to other languages.• Staff capacity to attend training and workshops could be low due to

more case loads.• Lower literacy level.y

Results from interviews with HP

Actions to overcome barriersActions to overcome  barriers

• Proper marketing and recommendation by staff. • Making sure health is being promoted/Sticking to the basic of

health messages.• Motivating participants to attend sessions by proving• Motivating participants to attend sessions by proving

lunch/snacks.• Always using resource materials tailored to their needs. For

instance bright coloured pictures with fewer words.

Results from interviews with HP

Suggestions of other resources or means to engage ith th l ti

• Pictorials, visuals, small booklets that are up to date and suit

with the population

population (adapted to each culture and language).• Breaching the time lag in translating resources to other languages

to facilitate timely reach to other non-English speaking populationto facilitate timely reach to other non English speaking population.• Identifying and integrating local champions in the community so

as to base services on their needs as opposed to their perceived needs.

• Use of i-pad.• Provision of lunch• Provision of lunch.

ConclusionsConclusions

• Breastfeeding is the standard practice for feeding infants in this g p gsample of Roma mothers living in Glasgow.

• There is good understanding on the correct age to introduce cow’s milk but further re enforcement of the message is neededmilk but further re-enforcement of the message is needed.

• Advice on infant feeding is provided mostly by mother and – in laws-but there is high appreciation of the health visitors role.

• HV actions messages are highly respected and they said there is no need of more information/help as what they get is fine.

• Pictorial resource: Most mothers indicated preference for the photos• Pictorial resource: Most mothers indicated preference for the photos.