State and Local WIC-Screener, Staff, Personnel

OMB Approval No. 0584-XXXX

Approval Expires: XX/XX/20XX

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?

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

2. 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

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

3. 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

4. How old are you?

 24 or younger

 25 to 34

 35 to 44

 45 to 54

 55 or older

5. 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)

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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

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

 None  Little  Some  Substantial  I don’t know

3. Parents/caregivers offering fruits and vegetables

 None  Little  Some  Substantial  I don’t know

4. Parents/caregivers offering whole grain foods

 None  Little  Some  Substantial  I don’t know

5. Parents/caregivers offering healthy snacks

 None  Little  Some  Substantial  I don’t know

6. Parents/caregivers offering the recommended amount of juice

 None  Little  Some  Substantial  I don’t know

7. Maintaining healthy weights for infants and toddlers

 None  Little  Some  Substantial  I don’t know

12. 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

13. 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.

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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

2. Early introduction of solids

 Not confident

 Somewhat confident

 Confident

 Very confident

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

3. 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

4. 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

5. 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

6. 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

7. Overfeeding

 Not confident

 Somewhat confident

 Confident

 Very confident

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

8. 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

20. 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

21. 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

22. 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

23. 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

2. Problems establishing a sufficient milk supply

 Not confident  Somewhat confident  Confident  Very confident

3. Lack of support from family or friends to breastfeed

 Not confident  Somewhat confident  Confident  Very confident

4. Strategies for returning to work or school

 Not confident  Somewhat confident  Confident  Very confident

5. Participant’s doctor suggested adding formula

 Not confident  Somewhat confident  Confident  Very confident

24. 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

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

 Not confident

 Somewhat confident

 Confident

 Very confident

26. 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

27. 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.

28. 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.

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

 Strongly Disagree  Disagree  Neutral  Agree  Strongly Agree

30. 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.

31. 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

32. 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.)

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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.

43. 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

2. A mother who has breastfed successfully in the past

 0

 1-2

 3-4

 5 or more

3. A mother who reports problems or concerns with breastfeeding

 0

 1-2

 3-4

 5 or more

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

 Yes

 No

45. 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.

46. Do you have children?

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

 No

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

 Yes

 No

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

 Yes

 No

49. 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

50. 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.

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

 Strongly Disagree  Disagree  Neutral  Agree  Strongly Agree

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

 Yes

 No

53. 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.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB number.  The valid OMB control number for this information collection is 0584-XXXX.  The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.