Introduction: This research was commissioned by Tower Hamlets Public Health Team and Tower Hamlets Together. The study was carried out by the Food Nutrition and Public Health Division of the University of Westminster. The aim of the research was to gain a greater understanding of the factors that influence mother’s perceptions and practices in relation to infant and young child feeding and oral health in Tower Hamlets. The research will feed into the THPHT restructuring decisions, being finalised in October 2017. The borough has prioritised increased investment into supporting improvements in early years public health and nutrition outcomes, especially in relation to improving infant feeding practices since 2011.
Methodology: A qualitative methodology was applied to capture an in-depth view of mother’s and service providers practices and perceptions, in relation to early years nutrition and oral health. The target group were mothers with children under five, service providers and carers. The participants were selected using purposeful, convenience and snowball sampling methods. Data was collected using key informant interviews, focus group discussions and direct observation of health promotion classes. In all, 36 key informant interviews, 3 direct observations and 18 focus group discussions were carried out throughout the borough. The focus group discussions included 144 participants including 95 mothers, 21 service providers, seventeen expectant parents, eight husbands and three mothers in laws. On June 9th a workshop was held to present the initial findings and get feedback from the key informants and service providers in the borough. A thematic analysis was used to determine key issues arising from the data, resulting in seven themes.
Findings: The themes identified included communication, access, trust, reaching the most vulnerable, policy adherence, capacity, leadership and governance. There was generally universal knowledge that breastfeeding is best for infants and that too much sugar is unhealthy. However, there was less clarity on what drinks and food contain the least sugar and when you should take your infant to see the dentist. Mothers reported mixed messages, pain and pressure from the media and families as the main reasons for changing from exclusive breastfeeding to mixed feeding, most mothers felt this was normal. Service providers are being trained in effective baby feeding but mothers reported a lack of support and mixed messages regarding feeding in public, mixed feeding and when to wean. Many mothers did not take their infants to the dentist until they started school. Mothers find adhering to healthy eating guidelines too expensive, and snacks like chicken and chips were not thought of as food, just snacks. Not all dentists were seeing infants. Mothers prefer face to face health information rather than leaflets.
Recommendations and conclusions: The borough should continue their support for the baby feeding initiative and increase the training of service providers in healthy eating and oral health. An annual workshop bringing together the different early years’ service providers could help increase integration and more effective support services. Lists with available dentists should be posted on the borough website, along with borough guidelines on healthy eating and oral health. A nutrition adviser should be available to coordinate growing nutrition concerns, like fussy eating and childhood obesity.