目的 探讨基于行为改变轮(BCW)理论的顺应喂养干预方案在6~12月龄婴儿及其照护者中的应用效果,为丰富顺应喂养干预具体实施方法提供参考。方法 采用便利抽样法,于2024年2—3月抽取青岛市某三级甲等医院儿童保健科的70名婴儿及其照护者为研究对象,按其入组时间先后顺序分为干预组和对照组,每组各35例。对照组接受儿童保健科的常规喂养指导,干预组在对照组基础上实施基于BCW理论的顺应喂养干预。采用顺应喂养行为评价量表(RFPAT)、婴儿饮食行为问卷 (BEBQ)、婴儿年龄别体质量指数Z评分(BMI Z)对两组婴儿及其照护者的干预效果进行评估。结果 重复测量方差分析结果显示,两组不同时间点的顺应喂养行为得分和饮食行为的食物响应、食物喜好、进食缓慢和过饱响应维度得分,以及婴儿BMI Z评分比较,在组间、时间及交互效应上均有统计学意义(P＜0.05);干预组在干预3、6个月的顺应喂养行为和食物喜好得分均高于对照组(P＜0.05),食物响应、进食缓慢、过饱响应得分以及婴儿BMI Z评分均低于对照组(P＜0.05)。结论 基于BCW理论的顺应喂养干预能显著提高照护者的顺应喂养水平,降低婴儿饮食行为问题的发生,促进婴儿健康的体格发展状态。
Abstract
Objective To evaluate the effectiveness of a responsive feeding intervention program based on the Behaviour Change Wheel (BCW) theory among infants aged 6 - 12 months and their caregivers, in order to provide a reference for enriching specific implementation methods of responsive feeding interventions. Methods A convenience sampling method was used to select 70 infants and their caregivers from the child health clinic of a tertiary hospital in Qingdao between February and March 2024.Participants were sequentially assigned to either the intervention group (n=35) or the control group (n=35) based on enrollment time.The control group received routine feeding guidance from the child health clinic, while the intervention group additionally received a BCW-based responsive feeding intervention.The intervention effects were assessed using the Responsive Feeding Parent Assessment Tool (RFPAT), the Baby Eating Behaviour Questionnaire (BEBQ), and the infant BMI-for-age Z-score (BMI Z). Results Repeated measures ANOVA showed statistically significant differences between the two groups in responsive feeding behavior scores, BEBQ subscale scores (food responsiveness, food fussiness, slowness in eating, and satiety responsiveness), and infant BMI Z-scores across time points, with significant group, time, and interaction effects (P<0.05).At 3 and 6 months post-intervention, the intervention group exhibited higher responsive feeding behavior and food fussiness scores (P<0.05) but lower food responsiveness, slowness in eating, satiety responsiveness scores, and infant BMI Z-scores compared to the control group (P<0.05). Conclusion The BCW-based responsive feeding intervention can significantly improve caregivers' responsive feeding practices, reduce infant feeding behavior problems, and promote healthier physical growth in infants.
关键词
行为改变轮理论 /
顺应喂养 /
婴儿 /
照护者 /
生长发育
Key words
behavior change wheel theory /
responsive feeding /
infants /
caregivers /
growth and development
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参考文献
[1] Ng M, Fleming T, Robinson M, et al.Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013:A systematic analysis for the Global Burden of Disease Study 2013[J].Lancet, 2014, 384(9945):766-781.
[2] 中国居民营养与慢性病状况报告(2020年)[J].营养学报,2020,42(6):521.
Report on nutrition and chronic diseases in China (2020)[J].Acta Nutr Sinica, 2020,42(6) :521.(in Chinese)
[3] Hale I, Fergus T, Buhler H, et al.Raise (raising infants to be smart eaters) pilot study[J].Child Obes, 2023, 19(1):25-33.
[4] 王雪,李智慧,孔燕,等.喂养行为在母亲喂养焦虑情绪与婴儿生长发育间的中介效应[J].中国儿童保健杂志,2024,32(8):918-923.
Wang X, Li ZH, Kong Y, et al.Mediating effect of maternal feeding behavior on the relationship between Maternal feeding anxiety and grow than development to infants[J].Chin J Child Health Care, 2024,32(8):918-923.(in Chinese)
[5] 王健,朱大乔,李芳芳.父母喂养行为与其学龄前子女进食行为的作用关系[J].中国儿童保健杂志,2020,28(6):645-648.
Wang J, Zhu DQ, Li FF.Review on the correlations between parental feeding practices and their preschool children's eating behaviors[J].Chin J Child Health Care, 2020,28(6):645-648.(in Chinese)
[6] 安美静,刘西瑶,龙超,等.顺应喂养相关行为与婴幼儿饮食行为关系的研究进展[J].中华实用儿科临床杂志,2023,38(4):309-312.
An MJ, Liu XY, Long C, et al.Research progress on the association between responsive feeding practices and infant and toddler's eating behavior[J].Chin J Appl Pediatr, 2023,38(4) :309-312.(in Chinese)
[7] Black MM, Aboud FE.Responsive feedingis embedded in a theoretical framework of responsive parenting[J].J Nutr, 2011, 141(3):490-494.
[8] Black MM, Tofail F, Hodges EA, et al.Rethinking responsive feeding:Insights from bangladesh[J].Nutrients, 2022, 14(15).
[9] Ruggiero CF, Trexberg KM, Moore AM, et al. Applying the family stress model to responsive feeding and early obesity prevention[J]. Appetite, 2024, 200:107515.
[10] Morandi A, Tommasi M, Soffiati F, et al.Prevention of obesity in toddlers (PROBIT):A randomised clinical trial of responsive feeding promotion from birth to 24 months[J].Int J Obes (Lond), 2019, 43(10):1961-1966.
[11] Saadeh MR.A new global strategy for infant and young child feeding[J].Forum Nutr, 2003, 56:236-238.
[12] 中国营养学会.中国居民膳食指南(2016)[M].北京:人民卫生出版社,2016.
Chinese Nutrition Society.Dietary guidelines for Chinese Residents (2016)[M].Beijing:People's Medical Publishing House, 2016.(in Chinese)
[13] Black MM, Hurley KM.Responsive feeding:Strategies to promote healthy mealtime interactions[J].Nestle Nutr Inst Workshop Ser, 2017, 87:153-165.
[14] Michie S, van Stralen MM, West R.The behaviour change wheel:A new method for characterising and designing behaviour change interventions[J].Implement Sci, 2011, 6:42.
[15] Toomey E, Matvienko-Sikar K, Doherty E, et al.A collaborative approach to developing sustainable behaviour change interventions for childhood obesity prevention:Development of the choosing healthy eating for infant health (CHErIsH) intervention and implementation strategy[J].Br J Health Psychol, 2020, 25(2):275-304.
[16] 李明霞,魏猛,董菊.6～36月龄婴幼儿顺应性喂养行为及相关危险因素分析[J].新疆医科大学学报,2020,43(12):1626-1629.
Li MX, Wei M, Dong J.Compliance feeding practice and related risk factors of infants aged 6-36 months[J].Journal of Xinjiang Medical University, 2020,43(12):1626-1629.(in Chinese)
[17] 孙亚莲,何小颖,曾嘉颖,等.早产儿食物转换期顺应喂养情况初步研究[J].中国儿童保健杂志,2020,28(1):78-81.
Sun YL, He XY, Zeng JY, et al.Preliminary study on responsive feeding of premature infants during food conversion period[J].Chin J Child Health Care, 2020,28(1):78-81.(in Chinese)
[18] Allison LD, Margaret KM, Maree JN, et al.Outcomes of an early feeding practices intervention to prevent childhood obesity.[J].Pediatrics,2013,132(1):e109-e118.
[19] 刘岩,孔燕,李智慧,等.顺应喂养行为评价量表的汉化及信效度检验[J].现代预防医学,2022,49(20):3707-3711.
Liu Y, Kong Y, Li ZH, et al.Reliability and validity of Chinese version of responsive feeding practices assessment tool[J].Modern Preventive Medicine, 2022,49 (20) :3707-3711.(in Chinese)
[20] Zhang H, Yang X, Xu T, et al.Preliminary evaluation of the Chinese version of the Baby Eating Behaviour Questionnaire[J].Child Care Health Dev, 2021, 47(5):627-634.
[21] De Onis M, Garza C, Onyango AW, et al.WHO growth standards for infants and young children[J].Arch Pediatr, 2009, 16(1):47-53.
[22] 张曦美,王海燕,马洁,等.不同喂养方式下0～12月龄婴幼儿体格发育及营养状况研究[J].中国乳品工业,2022,50(9):10-14.
Zhang XM, Wang HY, Ma J, et al.Effects of different feeding methods on physical development and nutritional status of infants aged 0~12 months[J].China Dairy Industry, 2022,50(9):10-14.(in Chinese)
[23] 王伟,张月芳,何红茹,等.早期养育理念与行为干预对婴幼儿喂养及生长发育的影响[J].中国儿童保健杂志,2021,29(3):258-261,267.
Wang W, ZhangYF, He HR, et al.Effects of early parenting ideas and behavior intervention on feeding and growth of infants[J].Chin J Child Health Care, 2021,29(3):258-261,267.(in Chinese)
[24] 翟相颖,周楠.祖辈喂养与儿童超重肥胖关系的研究进展[J].中国学校卫生,2022,43(12):1901-1905,1910.
Zhai XY, Zhou N.Research progress on the relationship between generational feeding behavior and childhood overweight and obesity[J].Chin J Sch Health, 2022,43(12) :1901-1905,1910.(in Chinese)
[25] World Health Organization.Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services:The revised Baby-friendly Hospital initiative:2018 implementation guidance:Frequently asked questions[EB/OL].(2020-02-11)[2024-02-02].https://www.who.int/publications/i/item/9789240001459.
[26] Ruggiero CF, Hohman EE, Birch LL, et al.INSIGHT responsive parenting intervention effects on child appetite and maternal feeding practices through age 3 years[J].Appetite, 2021, 159:105060.
[27] Jansen PW, Roza SJ, Jaddoe VW, et al.Children's eating behavior, feeding practices of parents and weight problems in early childhood:Results from the population-based generation R study[J].Int J Behav Nutr Phys Act, 2012, 9:130.
[28] Wright AS, Guthrie-Dixon N, Tulloch-Reid MK, et al.Maternal feeding styles in infancy predict child body mass index z-scores at 72 months:Findings from a cohort of Jamaican children[J].Front Public Health, 2023, 11:1161808.
[29] Wang J, Winkley K, Wei X, et al.The relationships between caregivers' self-reported and visual perception of child weight and their non-responsive feeding practices:A systematic review and meta-analysis[J].Appetite, 2023, 180:106343.
[30] Noor Shafina MN, Abdul Rasyid A, Anis Siham ZA, et al.Parental perception of children's weight status and sociodemographic factors associated with childhood obesity[J].Med J Malaysia, 2020, 75(3):221-225.
[31] Spill MK, Callahan EH, Shapiro MJ, et al.Caregiver feeding practices and child weight outcomes:A systematic review[J].Am J Clin Nutr, 2019, 109(Suppl 7):990-1002.
[32] Slater V, Rose J, Olander E, et al.Barriers and enablers to caregivers responsive feeding behaviour (CRiB):A mixed method systematic review protocol[J].HRB Open Res, 2020, 3:2.
[33] 卫生健康委网站.国家卫生健康委办公厅关于印发婴幼儿喂养健康教育核心信息的通知[EB/OL].(2020-07-29)[2024-10-11].https://www.gov.cn/zhengce/zhengceku/2020-08/01/content_5531915.htm.
基金
青岛市医疗卫生重点学科建设项目(2025—2027年)
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