The content is designed to make health professionals reflect on their own counseling techniques and the current structure of the WIC program. It is also meant to generate a dialogue about the problem of childhood obesity and encourage local and state WIC programs to identify barriers and solutions to addressing childhood obesity.
While the primary target audience is WIC health professionals, those lacking public nutrition experience − undergraduate nutrition students, dietetic interns, students in a variety of health fields including psychology, nursing and medicine − may also benefit.
Beyond Nutrition Counseling: Reframing the Battle against Obesity may be used alone or in conjunction with a facilitated group discussion (FGD) as an intervention to alter the perceptions of WIC health professionals about childhood obesity. During nutrition counseling, many parents feel alienated or blamed, and many providers feel the parents are unmotivated to support sustained changes in the family’s diet. The goal of the video is to help overcome this impasse in communication.
The intervention is intended to improve nutrition counseling skills. Rather than teach counseling skills, however, the intervention provides a stimulus for discussion about why current approaches may be unsuccessful (barriers) and what changes might be required for more successful counseling (solutions).
The video is ideally used in conjunction with a discussion guide for conducting a facilitated group discussion. The guide encourages discussion among health professionals to identify ways in which WIC might be more effective in addressing childhood overweight.
Following a brief introduction about why and how the video was developed, the 20-minute video is shown. A facilitated group discussion follows and is designed to help health professionals articulate a) barriers to preventing and managing overweight among children enrolled in WIC and b) steps that might be taken to prevent and manage overweight among the children.
With this conceptual framework in mind, an evaluation of the intervention would involve assessing whether it altered the perceptions of WIC health professionals about the barriers and solutions related to the problem of obesity. It does not aim to make behavioral assessment of counseling competencies − a much later stage in the process of behavior change.
Outcome variables
Below are suggested objectives that can be used during your intervention.
- To increase awareness of how WIC families perceive the problem of childhood obesity and how the WIC program currently counsels families.
- To increase awareness of the challenges faced by WIC families, particularly in the area of child rearing or parenting, as they try to prevent or manage obesity in their children.
- To generate specific ideas about how to best address the issue of childhood obesity during WIC counseling sessions.
Evaluation tools
To measure changes in perception resulting from this intervention, you may choose to use the evaluation tools described below. These tools were used as part of the Kentucky FitWIC Project in its formal evaluation of the intervention and can be modified to suit your specific needs. We suggest that the evaluation instruments be completed anonymously to encourage participants to answer as honestly as possible. The evaluation used by the Kentucky FitWIC Project consisted of three components:
- Demographic Questionnaire. This 13-item questionnaire is useful in large training sessions to gather information about the characteristics of the participants such as race, age, perceived self-efficacy in counseling, self-reported height and weight, professional certification and WIC counseling experience.
- Assessment Form. This form consists of two open-ended questions. The first is designed to assess the FGD participant’s perceptions about barriers to obesity prevention in WIC. The second is designed to assess the FGD participant’s perceptions about possible solutions to overcoming these barriers.
- Follow up Questionnaire.This questionnaire is designed to determine how successful the WIC health professionals feel they have been in implementing the counseling strategies suggested during the FGD and what further training might be most helpful. It is to be mailed to participants four to six weeks after the FGD.
The basic structure of the FGD is outlined in the Discussion Guide. The format consists of an overview of the video, showing the video (20 minutes) and conducting an FGD about the video (40 minutes). In addition, the evaluation tools described above may also be used, adding an additional 15 minutes.
At the end of the session, participants will be left with a specific list of counseling strategies that could be implemented immediately and that would not necessarily require structural changes in WIC. These strategies might include examples of open-ended questions to use with clients when discussing obesity.
