State and Local WIC-Screener, Staff, Personnel

WIC Infant and Toddler Feeding Practices Study-2

App.MM.1_Eng.Local Staff Online Survey.V2

State and Local WIC-Screener, Staff, Personnel

OMB: 0584-0580

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APPENDIX MM.1

Feeding My Baby Study

Local Staff Online Survey Questions - ENGLISH


Thank you for taking the time to complete this survey. United States Department of Agriculture (USDA), Food and Nutrition Service (FNS) is sponsoring a national study to collect data on WIC infant and toddler feeding practices. FNS has contracted with Westat and Altarum to conduct this study. As part of the study, FNS would like the input of WIC staff about aspects of the WIC program such as the nutrition education provided to WIC participants and breastfeeding promotion and support efforts. It should take you about 20-30 minutes to answer the questions in this survey. Everything you say is confidential. Your responses will be combined with responses from other staff at your WIC program and staff in other WIC offices across the country. We will include the responses to the survey in a report for FNS, but your name will not be included anywhere in the report. Nothing that you say in this survey will affect your employment with WIC.



Demographics and Background

  1. Which of the following best describes your primary role in the WIC Program?

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Note: The Support Staff/Clerk/Receptionist/
Screener will receive only the questions in yellow. Everyone else will receive all questions.


Breastfeeding Peer Counselors and Breastfeeding Coordinators will receive the questions in blue as well as all other questions.


WIC Director/Coordinator/Manager

Dietitian/Nutritionist

Nurse

Breastfeeding Peer Counselor

Support Staff/Clerk/Receptionist/Screener

Nutrition Assistant/Nutrition Aide

Breastfeeding Coordinator



  1. Which of the following job functions do you perform on a daily basis? (Please check all that apply)

Provide nutrition education and counseling to high risk participants

Provide nutrition education and counseling to low risk participants

Conduct group nutrition education classes

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Note: This question can be used to analyze responses based on job function.

Provide breastfeeding support

Conduct breastfeeding classes

Assign or modify food packages

Issue breast pumps

None of the above









  1. How many years have you worked in WIC?

Less than 1 year

1 to 3 years

4 to 6 years

7 to 9 years

10 or more years

  1. How old are you?

24 or younger

25 to 34

35 to 44

45 to 54

55 or older

  1. What is your highest level of education?

Some high school or less

High school graduate/GED

Some college

Associates degree (AA)

Bachelor’s degree (BA/BS)

Master’s degree (MA/MS/MPH)

Doctorate degree (PhD/MD/JD)

  1. What additional credentials do you have? (Please check all that apply)

DTR (Registered Diet Technician)

RD (Registered Dietitian)

LD (Licensed Dietitian)

RN (Registered Nurse)

LPN (Licensed Practical Nurse)

MA (Medical Assistant)

CLC (Certified Lactation Counselor)

IBCLC (International Board Certified Lactation Consultant)

None of the above

  1. How confident are you in your ability to provide services to participants whose primary language is different than yours?

Not confident

Somewhat confident

Confident

Very confident

WIC Training

  1. What topics were covered in the training sessions you attended in the past year? (Please check all that apply)

Lactation/breastfeeding

Prenatal nutrition

Infant nutrition

Toddler feeding

Childhood nutrition

Counseling skills/VENA training

Approaching discussions around weight

Language training (for example, Spanish language training)

None of the above


For the following statement, please indicate if you strongly disagree, disagree, are neutral (neither agree nor disagree), agree, or strongly agree.

  1. I receive adequate training from the WIC program to help participants with infant and toddler feeding issues.

Strongly Disagree Disagree Neutral Agree Strongly Agree



WIC Program Impact

  1. The WIC program offers nutrition and breastfeeding information to participants. Please tell us how much of an influence you think the WIC program has on the following participant behaviors?

a. Deciding to breastfeed None Little Some Substantial I don’t know

b. Feeding infants appropriately None Little Some Substantial I don’t know

c. Offering healthy food choices

for toddlers None Little Some Substantial I don’t know

d. Maintaining healthy weights None Little Some Substantial I don’t know



WIC Food Packages

  1. Please tell us how much of an influence you think the WIC foods have on the following participant behaviors?

  1. A woman deciding to breastfeed her baby

None Little Some Substantial I don’t know

  1. Parents/caregivers adding supplemental foods at the recommended time

None Little Some Substantial I don’t know

  1. Parents/caregivers offering fruits and vegetables

None Little Some Substantial I don’t know

  1. Parents/caregivers offering whole grain foods

None Little Some Substantial I don’t know

  1. Parents/caregivers offering healthy snacks

None Little Some Substantial I don’t know

  1. Parents/caregivers offering the recommended amount of juice

None Little Some Substantial I don’t know

  1. Maintaining healthy weights for infants and toddlers

None Little Some Substantial I don’t know


  1. Do you feel adding supplemental formula in the first month of breastfeeding reduces breastfeeding success rates for WIC participants?

Yes

No

I don’t know

  1. How do you determine the amount of formula to provide for a partially breastfeeding infant? (Please choose the response that most closely matches how you decide how much formula is needed)

I provide the maximum amount of formula allowed for a partially breastfeeding infant

of that age

I assess how much formula the infant is drinking and offer the amount closest to that

I ask the mother how much formula she thinks she will need

I ask about the amount of breastfeeding the mother is currently doing and offer the

minimal amount of formula to meet the nutritional needs of the infant

I do not have a role in determining the amount of formula to provide

For the following statement, please indicate if you strongly disagree, disagree, are neutral (neither agree nor disagree), agree, or strongly agree.

  1. I am able to make changes or substitutions to WIC participants’ food packages to meet their individual nutritional needs and preferences.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I do not assign food packages for WIC participants



  1. Do the following diets provide adequate nutrition for infants/toddlers? Please indicate if you strongly disagree, disagree, agree, strongly agree, or don’t know.

a. Vegetarian (no meat)

Strongly Disagree Disagree Agree Strongly Agree I don’t know

b. Vegan (no animal products)

Strongly Disagree Disagree Agree Strongly Agree I don’t know

c. Kosher (Jewish)

Strongly Disagree Disagree Agree Strongly Agree I don’t know

d. Halal (Islamic)

Strongly Disagree Disagree Agree Strongly Agree I don’t know


Influences on Infant & Toddler Feeding Practices

  1. Below is a list of some things that support healthy weights for infants and toddlers. Of the choices listed below, please choose up to 3 topics that you discuss most often with WIC participants.

Having enough food to eat

Eating fruits and vegetables

Eating whole grains

Breastfeeding

Having family meals

Offering healthy snacks

Being physically active

In my role at WIC, I do not have conversations about weight issues

  1. Below is a list of some things that make it challenging for WIC infants and toddlers to achieve a healthy weight. Of the choices listed below, please choose up to 3 challenges that you discuss most often with WIC participants.

Introducing solids too early

Remaining on the bottle too long

Overfeeding/offering portion sizes that are too large

Offering too many high fat foods

Offering too much milk

Offering too many high sugar beverages

Watching T.V.

Offering fast food

In my role at WIC, I do not have conversations about weight issues



  1. Below is a list of some common inappropriate infant feeding practices. Please choose the up to 3 you see most frequently in your sessions with WIC participants.

Inappropriate formula dilution

Early introduction of solids

Propping the bottle (leaving an infant unattended with a bottle)

Food or infant cereal in the bottle

Beverages other than formula or breastmilk in the bottle

Early introduction of cow’s milk

Overfeeding

Introduction of sugar-sweetened beverages (soda, pop, or sports drinks)

  1. How confident are you when talking with WIC participants about the inappropriate feeding practices listed below? Please indicate your confidence level for each issue.

  1. Inappropriate formula dilution

Not confident

Somewhat confident

Confident

Very confident

In my role at WIC, I do not discuss this topic with participants

  1. Early introduction of solids

Not confident

Somewhat confident

Confident

Very confident

In my role at WIC, I do not discuss this topic with participants

  1. Propping the bottle (leaving an infant unattended with a bottle)

Not confident

Somewhat confident

Confident

Very confident

In my role at WIC, I do not discuss this topic with participants

  1. Food or infant cereal in the bottle

Not confident

Somewhat confident

Confident

Very confident

In my role at WIC, I do not discuss this topic with participants



  1. Beverages other than formula or breastmilk in the bottle

Not confident

Somewhat confident

Confident

Very confident

In my role at WIC, I do not discuss this topic with participants

  1. Early introduction of cow’s milk

Not confident

Somewhat confident

Confident

Very confident

In my role at WIC, I do not discuss this topic with participants

  1. Overfeeding

Not confident

Somewhat confident

Confident

Very confident

In my role at WIC, I do not discuss this topic with participants

  1. Introduction of sugar-sweetened beverages (soda, pop, or sports drinks)

Not confident

Somewhat confident

Confident

Very confident

In my role at WIC, I do not discuss this topic with participants



Benefits and Barriers to Breastfeeding

  1. Below is a list of some of the common benefits associated with breastfeeding. Of the choices listed below, please choose up to 3 benefits that you discuss most often with WIC participants.

Infants who breastfeed are sick less often/fewer ear infections

Breastmilk changes to meet the nutritional needs of the growing infant

Breastmilk is easier to digest than formula

Breastfed babies have lower rates of obesity later in life

Breastfeeding is convenient (no bottles, preparation, etc.)

Breastfeeding can save money

Breastfeeding helps the mother and child bond

Breastfeeding women may have lower risk of some types of cancer (e.g. breast,
ovarian, cervical)

Breastfeeding is better for the environment

Breastfeeding may improve infants’ IQs

  1. Below is a list of some of the common challenges associated with breastfeeding. Of the choices listed below, please choose up to 3 challenges that you discuss most often with WIC participants.

Infants who have difficulty nursing or do not like breastfeeding

Sore/cracked/bleeding nipples

Inverted/flat nipples

Concerns around making enough milk

Advice from friends or family members to use formula

Breastfeeding in public

Issues around sick or preterm infants

Issues around going back to work/school

  1. Below are 3 statements. For each, please tell me whether or not you think this statement reflects WIC’s position about breastfeeding babies.

a. WIC encourages mothers to breastfeed their babies Y N

b. WIC encourages mothers to feed their babies formula Y N

c. WIC encourages mothers to breastfeed their babies without using formula Y N



Nutrition and Breastfeeding Education

  1. How confident are you when talking with WIC participants about the breastfeeding situations/issues listed below? Please rank your confidence level for each issue.

  1. Participants who do not want to breastfeed

Not confident Somewhat confident Confident Very confident

  1. Problems establishing a sufficient milk supply

Not confident Somewhat confident Confident Very confident

  1. Lack of support from family or friends to breastfeed

Not confident Somewhat confident Confident Very confident

  1. Strategies for returning to work or school

Not confident Somewhat confident Confident Very confident

  1. Participant’s doctor suggested adding formula

Not confident Somewhat confident Confident Very confident

  1. How comfortable are you talking about weight issues with parents/caregivers of overweight WIC toddlers?

Not comfortable

Somewhat comfortable

Comfortable

Very comfortable

In my role at WIC, I do not discuss this topic with participants

  1. How confident are you that you can help WIC infants/toddlers maintain a healthy body weight?

Not confident

Somewhat confident

Confident

Very confident

  1. Of the choices listed below, please choose up to 3 things that you feel make it most difficult to talk with parents/caregivers about their infant or toddler’s weight issues.

Parents/caregivers don’t recognize the child has a weight issue

Parents/caregivers take their child’s weight personally and become insulted when

discussing the child’s weight issues

Parents/caregivers don’t follow through with suggestions

Time limitations in a WIC clinic make effective counseling difficult

There is no follow up until the next certification

The doctor doesn’t talk with the parents/caregivers about their child’s weight

In my role at WIC, I do not discuss this topic with participants



  1. Below are several recommendations for addressing overweight toddlers. Of the choices listed below, please choose up to 3 recommendations that you discuss most often with WIC participants.

Following the child’s hunger/satiety cues

Offering low fat foods/snacks

Adding physical activity

Weaning from the bottle

Reducing juice intake

Increasing fruits and vegetables

Having family meals

Offering appropriate portions/servings

Reducing sugar-sweetened beverages (like soda, pop, or sports drinks)

In my role at WIC, I do not discuss this topic with participants

For the following statement, please indicate if you strongly disagree, disagree, are neutral (neither agree nor disagree), agree, or strongly agree.

  1. Group education is an effective way to help participants with infant and toddler feeding issues.

Strongly Disagree Disagree Neutral Agree Strongly Agree



Nutrition and Breastfeeding Supplies and Materials

For the following statement, please indicate if you strongly disagree, disagree, are neutral (neither agree nor disagree), agree, or strongly agree.

  1. I have the education materials necessary to assist participants in their eating, breastfeeding and activity choices.

Strongly Disagree Disagree Neutral Agree Strongly Agree

  1. Does your program offer breast pumps for breastfeeding women?

Yes (Note: If response is Yes, questions 31 and 32 will appear)

No

For the following statement, please indicate if you strongly disagree, disagree, agree, strongly agree, or don’t know.

  1. Having breast pumps available for WIC participants improves the likelihood that they will breastfeed longer.

Strongly Disagree Disagree Agree Strongly Agree I don’t know

  1. Which type of WIC participant do you think should receive a breast pump from WIC? (Please check all that apply)

Mothers of infants who are in the hospital/NICU

Mother who request a breast pump

Mothers who are separated from their infant

Mothers who have difficulty nursing due to breast/nipple concerns

Mothers who are returning to work or school

All breastfeeding women

I don’t know



Current Nutrition and Breastfeeding Recommendations

Please choose the response below that you think most closely matches WIC’s recommendations for feeding infants/toddlers. (Note: there may be more than one correct response for each question. Please choose the response that you think most closely matches WIC’s recommendations.)



  1. When is the best time for infants to start eating foods other than breastmilk or formula?

Approximately 3 months

4 to 5 months

Approximately 6 months

7-9 months

As soon as the infant can sit unsupported and take food from a spoon

  1. What is the best type of food for parents/caregivers to introduce first (other than breastmilk or formula)?

Vegetables

Infant cereal

Fruits

Meat

A combination of the above

It does not matter as long as they are ready

  1. How long should a woman breastfeed?

3 to 5 months

Approximately 6 months

7 to 10 months

Approximately 1 year

Women should breastfeed for as long as they wish

Women should formula feed

  1. How do you know when a baby is full?

She/he will refuse any more

She/he will turn their head

She/he spits out the nipple

His/her eating will slow down

All of the above

None of the above



  1. What is the best age to wean a baby completely off the bottle?

4 to 5 months

Approximately 6 months

7 to 9 months

10 to 11 months

Approximately 12 months

13 to 15 months

  1. What is the best age to transition to whole milk?

4 to 5 months

Approximately 6 months

7 to 9 months

10 to 11 months

Approximately 12 months

13 to 14 months

  1. What is the best age to transition to low-fat milk?

9 months to 11 months

Approximately 12 months

13 to 15 months

16 to 18 months

19 to 23 months

Approximately 2 years



Breastfeeding Peer Counselor Program

  1. Do you have a breastfeeding peer counselor at your WIC site?

Yes (Note: If response is Yes, questions 41 and 42 will appear)

No

I am not sure

  1. How much of an influence do you think the breastfeeding peer counselor program has on the length of time that women breastfeed?

None Little Some Substantial I don’t know

  1. Of the choices listed below, please choose up to 3 situations in which the breastfeeding peer counselor program is most valuable.

Mother is unsure about breastfeeding

Mother reports a problem with breastfeeding

Mother is breastfeeding for the first time

Mother is concerned about returning to work or school

Mother requests the extra support of a peer counselor

Mother or baby has a medical concern

I am not sure


Additional questions for breastfeeding peer counselors and coordinators only

The following three questions concern your experience as peer counselors when contacting WIC participants during the first 10 days after birth.



  1. How many times, on average, do you speak with a woman (in person or on the phone) during the first 10 days after birth?

[Choose one response for each of the examples below]

  1. A mother who is breastfeeding for the first time

0

1-2

3-4

5 or more


  1. A mother who has breastfed successfully in the past

0

1-2

3-4

5 or more


  1. A mother who reports problems or concerns with breastfeeding

0

1-2

3-4

5 or more


  1. Do you attempt to contact mothers who said they were undecided about breastfeeding during the first 10 days?

Yes

No


  1. Overall, what percentage of the mothers that you attempt to contact during the first 10 days do you speak with at least once?

0%

1-25%

26-50%

51-75%

76-100%



Staff Health Behaviors and Background

Please share with us a little about your background and behaviors.

  1. Do you have children?

Yes (Note: If response is Yes, questions 47 and 48 will appear)

No

  1. Did you (or your spouse) breastfeed your child/children?

Yes

No

  1. Do you use your (or your spouse’s) breastfeeding experiences when talking to participants?

Yes

No

  1. Which of the following best describes how you feel about YOUR weight?

I am at a healthy weight

I am at an unhealthy weight

I don’t know

  1. How supportive is your workplace in helping you to make healthy food choices?

Very supportive

Supportive

Somewhat unsupportive

Very unsupportive

For the following statement, please indicate if you strongly disagree, disagree, are neutral (neither agree nor disagree), agree, or strongly agree.

  1. I serve as a role model for healthy eating and activity behaviors for my participants.

Strongly Disagree Disagree Neutral Agree Strongly Agree

  1. Do you think that your own eating and physical activity habits influence the way you talk to WIC participants.

Yes

No

  1. Is there anything else you would like to share with us?

Free text field (up to 250 characters)

Thank you for taking the time to complete this survey!

Your opinions are valuable. The findings from this study will assist WIC staff in providing superior nutrition and breastfeeding support and could assist other maternal and child programs as well.














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