Nurturing Care Family Navigator: Establishing Practices for Navigating Maternal-Child Food Insecurity
Overview
- Phase
- N/A
- Intervention
- Control: Non-Navigation Cohort
- Conditions
- Not specified
- Sponsor
- University of Nevada, Las Vegas
- Enrollment
- 72
- Locations
- 1
- Primary Endpoint
- Intense Navigation Completion
- Status
- Active, Not Recruiting
- Last Updated
- 2 months ago
Overview
Brief Summary
The goal of this pilot randomized controlled trial is to determine whether a 6-month behavioral health intervention with a Nurturing Care Family Navigator (NCFN) improves levels of food security among postpartum low-income Medicaid or uninsured women identified as having very low or low food security in the past 12 months. We hypothesize that a behavioral health intervention applying a multisectoral nurturing care navigation approach facilitating access to health, nutrition, early learning, responsive care, and security and safety resources is likely to decrease levels of maternal-child food insecurity. The main question it aims to answer is:
- Does the behavioral health intervention with a Nurturing Care Family Navigator (NCFN) improves levels of food security? Outcome 1: Improve levels of food security
- Does the behavioral health intervention with a Nurturing Care Family Navigator (NCFN) increase knowledge to navigate barriers across the four pillars of food insecurity? Outcome 2: Increase knowledge across the four pillars of food insecurity
- Does the behavioral health intervention with a Nurturing Care Family Navigator (NCFN) increase self-efficacy to secure and sustain enrollment with community nurturing care services? Outcome 3: Increase self-efficacy to secure and sustain enrollment with community nurturing care services
Researchers will compare levels of food security among those receiving a navigation behavioral health intervention (consisted of 1:1 tailored navigation session and an educational workbook) compared to those receiving an educational workbook with messages across the four pillars of food insecurity (standard of care).
Participants will:
- Engage in intense weekly navigation 1:1 tailored session for 3 months
- Engage in follow up monthly navigation 1:1 tailored session for 3 months
- Participate in evaluation calls with a research assistant at enrollment, 3, 6, 12 months
Detailed Description
The Nurturing Care Family Navigator (NCFN) is a social behavioral health intervention inspired by the Nurturing Care Framework which provides an evidence-based roadmap across and within five components (i.e., health, nutrition, early learning, security and safety, and responsive caregiving) to transform child rights into equitable actions to address threats and promote optimal early childhood development. We hypothesize that applying a multisectoral nurturing care navigation approach facilitating access to health, nutrition, early learning, responsive care, and security and safety community resources is likely to decrease levels of maternal-child food insecurity. The NCFN is the navigation program under investigation. NCFN is a comprehensive barrier-focused and long-term family-centered intervention that will offer screenings for food insecurity, referrals to community resources, and follow-up with families experiencing very low or low food security in the past 12 months assessed using the 8-item Abbreviated Child and Adult Food Security Scale (ACAFSS). The NCFN program is grounded in the Social Cognitive Theory (SCT) aiming to support families in overcoming barriers within and across the four pillars of food security (i.e., food availability, access to food, utilization, and stability). The goal of the NCFN is to increase knowledge (cognitive factors) and self-efficacy (behavioral factors) to navigate barriers across the four pillars of food insecurity by securing enrollment and sustaining engagement with a set of community nurturing care services (environmental factors) to improve levels of food security, and ultimately maternal-child health and nutrition outcomes of low-income families during the postpartum phase. The target population for the randomized controlled trial will consist of (1) low-income Medicaid or uninsured families with an infant one week postpartum attending the well child visit at a Pediatric clinic through UNLV Health; (2) identified as having very low or low food security in the past 12 months; and (3) residing in one of the zip codes within Clark County, Nevada. The intervention group will receive the NCFN program that will support families through 15 one-on-one sessions over 6 months after enrollment (a total of 15 sessions with 12 sessions in the first 3 months and 3 sessions in the last 3 months) and one year of follow up evaluation with a research assistant. The control group will receive an education workbook package and one year of follow up evaluation with a research assistant. Participants will undergo surveys at enrollment, three, six, and 12 months after enrollment (i.e., baseline, T2, T3, T4). Additionally, the research team will conduct interviews with navigators as well as clinical and non-clinical providers.
Investigators
Gabriela Buccini
Assistant Professor
University of Nevada, Las Vegas
Eligibility Criteria
Inclusion Criteria
- •Individuals postpartum low-income, Medicaid publicly funded or uninsured
- •Individuals 18 years or older
- •Individuals with infants up to two weeks postpartum
- •Ability to speak and read English or Spanish
- •Established patient at the UNLV Pediatric (at least one well-child visit)
- •Lives in one of the zip codes within Clark County, Nevada, United States
Exclusion Criteria
- •Intent to transfer care to an institution other than UNLV Pediatric
- •Infants who receive at birth any of the following diagnoses: Down syndrome, cleft lip and/or palate, congenital heart disease, neurological conditions, and cardiac problems.
Arms & Interventions
Control: Non-Navigation Cohort
Participants in the control group will receive an educational workbook with messages across the four pillars of food insecurity (standard of care). Non-navigation will be provided.
Experimental: Navigation Group
Participants who are randomized into the NCFN program will be assigned to a navigator. The NCFN will deliver the behavioral health navigation intervention consisted an educational workbook (standard of care) plus a total of 15 sessions tailored to the participant needs. The NCFN will offer support and referral to community resources (e.g., food, transportation, housing, healthcare-related). The navigator will provide intense weekly educational support and linkage to resources during the initial three months of the program and additional monthly follow up sessions during the last three months of the program.
Intervention: Nurturing Care Family Navigator
Outcomes
Primary Outcomes
Intense Navigation Completion
Time Frame: T2 (3 months)
Number of NCFN sessions completed (range 0-12). Engage in a total of 12 one-on-one session over three-months. Navigation interruptions/stoppages were considered incomplete intervention. A 90% navigation completion rate was chosen a priori to indicate a promising intervention.
Follow Up Navigation Completion
Time Frame: T3 (6 months)
Engage in a total of 3 follow up session over three-months after the end of the intense intervention (range 0-3). Number of follow-up sessions completed. A 90% navigation completion rate was chosen a priori to indicate a promising intervention.
Navigation Completion
Time Frame: T3 (6 months)
Engage in a total of 15 one-on-one session over six-months. Navigation interruptions/stoppages were considered incomplete intervention. A 90% navigation completion rate was chosen a priori to indicate a promising intervention.
Food Security Status Baseline
Time Frame: Baseline
Food security status will be determined by the sum of affirmative responses to the 8-item Abbreviated Child and Adult Food Security Scale (ACAFSS) in the past 12 months. ACAFSS scores range from 0 to 8. Higher scores represent greater food insecurity: 0-1 means the household is food secure; 2-4 means the household is low food security; 5-8 means the household is very low food security.
Food Security Status Point 1
Time Frame: Baseline and T2 (3 months)
Food security status will be determined by the sum of affirmative responses to the 8-item Abbreviated Child and Adult Food Security Scale (ACAFSS) in the past 30 days. ACAFSS scores range from 0 to 8. Higher scores represent greater food insecurity: 0-1 means the household is food secure; 2-4 means the household is low food security; 5-8 means the household is very low food security. Changes in scores and food security status will be examined between Baseline and T2 (3 months).
Food Security Status Point 2
Time Frame: Baseline and T3 (6 months)
The unabbreviated scale used to measure the participants' food security status is the Abbreviated Child and Adult Food Security Scale (ACAFSS), validated for 12 months and 30 days in the United States population. ACAFSS scores range from 0 to 8. Higher scores represent greater food insecurity: 0-1 means the household is food secure; 2-4 means the household is low food security; 5-8 means the household is very low food security. Changes in scores and food security status will be examined between Baseline and T3 (6 months)
Food Security Status Point 3
Time Frame: Baseline and T4 (12 months)
The unabbreviated scale used to measure the participants' food security status is the Abbreviated Child and Adult Food Security Scale (ACAFSS), validated for 12 months and 30 days in the United States population. ACAFSS scores range from 0 to 8. Higher scores represent greater food insecurity: 0-1 means the household is food secure; 2-4 means the household is low food security; 5-8 means the household is very low food security.Changes in scores and food security status will be examined between Baseline and T4 (12 months)
Secondary Outcomes
- Patient reported Perceived Barriers to Food Security(Baseline, T2 (3 months), T3 (6 months), T4 (12 months))
- Patient-reported Self-Efficacy for Food Security Scale(Baseline, T2 (3 months), T3 (6 months), T4 (12 months))
- Patient-reported Perceived Agency ("Seeking" Behavior)(Baseline, T2 (3 months), T3 (6 months), T4 (12 months))
- Patient-reported Maternal Diet Quality Index(Baseline, T2 (3 months), T3 (6 months), T4 (12 months))
- Patient-reported Breastfeeding Status(Baseline, T2 (3 months), T3 (6 months), T4 (12 months))
- Patient-reported Infant Feeding(Baseline, T2 (3 months), T3 (6 months), T4 (12 months))