Exploring Family-Medicine Providers’ Perspectives on Group Care Visits for Maternal and Infant Nutrition Education

Published:February 15, 2019DOI:



      Explore current maternal and infant nutrition education practices and family medicine primary care providers' views on a group care model to deliver nutrition education to mother–infant dyads.


      In-depth interviews.


      Family medicine clinics in 1 Midwestern US hospital system.


      Family medicine primary care providers (n = 17) who regularly see infants during well-baby visits.

      Phenomenon of Interest

      Current maternal and infant nutrition education practices; views on ideal way to deliver nutrition education to mother–infant dyads; feedback on group care model to deliver nutrition education to mother–infant dyads.


      Audio recordings transcribed verbatim and coded using conventional content analysis.


      Family medicine primary care providers are limited in the ability to provide maternal and infant nutrition education and desire a different approach. Group care was the preferred method; it was shared most frequently as the ideal approach to nutrition education delivery and participants reacted favorably when presented with this model. However, there were many concerns with group care (eg, moderating difficult conversations, program implementation logistics, sufficient group volume, and interruption in patient–provider relationship).

      Conclusion and Implications

      Family medicine primary care providers desire a different approach to deliver nutrition education to mother–infant dyads in clinic. A group care model may be well-accepted among family medicine primary care providers but issues must be resolved before implementation. These results could inform future group care implementation studies and influence provider buy-in.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access

      SNEB Member Login

      SNEB Members, full access to the journal is a member benefit. Login via the SNEB Website to access all journal content and features.


      Subscribe to Journal of Nutrition Education and Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Centering Healthcare Institute. Improving health by transforming care. Accessed December 4, 2018.

      2. Centering Healthcare Institute. Centering Healthcare Institute expansion announcement. Accessed December 4, 2018.

      3. Centering Healthcare Institute. Centering site locations. Accessed December 4, 2018.

        • Machuca H
        • Arevalo S
        • Hackley B
        • et al.
        Well baby group care: evaluation of a promising intervention for primary obesity prevention in toddlers.
        Child Obes. 2016; 12: 171-178
        • Selden TM
        Compliance with well-child visit recommendations: evidence from the Medical Expenditure Panel Survey, 2000–2002.
        Pediatrics. 2006; 118: e1766-e1778
        • Ndetan H
        • Jr Evans MW
        • Bae S
        • Felini M
        • Rupert R
        • Singh KP
        The health care provider's role and patient compliance to health promotion advice from the user's perspective: analysis of the 2006 National Health Interview Survey data.
        J Manipulative Physiol Ther. 2010; 33: 413-418
        • Bloomfield J
        • Rising SS.
        CenteringParenting: an innovative dyad model for group mother‐infant care.
        J Midwifery Womens Health. 2013; 58: 683-689
        • Manning KM
        • Ariza AJ
        • Massimino TK
        • Binns HJ
        Health supervision visits of very young children: time addressing 3 key topics.
        Clin Pediatr (Phila). 2009; 48: 931-938
        • Cheng C-Y
        • Fowles ER
        • Walker LO
        Postpartum maternal health care in the United States: a critical review.
        J Perinat Educ. 2006; 15: 34-42
        • Hibbard JH
        • Greene J
        What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs.
        Health Aff Proj Hope. 2013; 32: 207-214
        • Öhlund I
        • Hernell O
        • Hörnell A
        • Stenlund H
        • Lind T
        BMI at 4years of age is associated with previous and current protein intake and with paternal BMI.
        Eur J Clin Nutr. 2010; 64: 138-145
        • Skinner AC
        • Ravanbakht SN
        • Skelton JA
        • Perrin EM
        • Armstrong SC
        Prevalence of obesity and severe obesity in US children, 1999–2016.
        Pediatrics. February 2018; 142
        • Mayorga ME
        • Reifsnider OS
        • Yi Z
        • Hunt KJ
        Trends in BMI and obesity in U.S. women of childbearing age during the period of 1980–2010.
        Health Syst. 2014; 4: 176-186
        • Mannan M
        • Doi SA
        • Mamun AA
        Association between weight gain during pregnancy and postpartum weight retention and obesity: a bias-adjusted meta-analysis.
        Nutr Rev. 2013; 71: 343-352
      4. MacMillan Uribe AL, Olson BH. Exploring healthy eating and exercise behaviors among low-income breastfeeding mothers J Hum Lact. 2019;35:59–70.

        • Gerards SMPL
        • Kremers SPJ
        The role of food parenting skills and the home food environment in children's weight gain and obesity.
        Curr Obes Rep. 2015; 4: 30-36
        • Harvey-Berino J
        • Rourke J
        Obesity prevention in preschool Native-American children: a pilot study using home visiting.
        Obes Res. 2003; 11: 606-611
        • Taveras EM
        • Blackburn K
        • Gillman MW
        • et al.
        First Steps for Mommy and Me: a pilot intervention to improve nutrition and physical activity behaviors of postpartum mothers and their infants.
        Matern Child Health J. 2011; 15: 1217-1227
        • Chang M-W
        • Nitzke S
        • Brown R
        • Egan MJB
        • Bendekgey CM
        • Buist D
        Recruitment challenges and enrollment observations from a community based intervention (Mothers in Motion) for low-income overweight and obese women.
        Contemp Clin Trials Commun. 2017; 5: 26-33
        • Nilsen P
        Making sense of implementation theories, models and frameworks.
        Implement Sci. 2015; 10: 53
        • Mittal P.
        Centering Parenting: pilot implementation of a group model for teaching family medicine residents well-child care.
        Perm J. 2011; 15: 40-41
        • Michie S
        • van Stralen MM
        • West R
        The behaviour change wheel: a new method for characterising and designing behaviour change interventions.
        Implement Sci. 2011; 6: 42
        • Price L.
        Psychometric Methods.
        Guilford Press, New York, NY2017
      5. University of Wisconsin-Madison Department of Family Medicine and Community Health, All DFM Clinics Panel Demographic Report. Madison, WI2014
        • Kania-Richmond A
        • Hetherington E
        • McNeil D
        • Bayrampour H
        • Tough S
        • Metcalfe A
        The impact of introducing Centering Pregnancy in a community health setting: a qualitative study of experiences and perspectives of health center clinical and support staff.
        Matern Child Health J. 2017; 21: 1327-1335
      6. Given L. The Sage Encyclopedia of Qualitative Research Methods. Los Angeles, CA: Sage.

        • May T
        • Perry B
        Reflexivity and the practice of qualitative research..
        The Sage Handbook of Qualitative Data Analysis. Sage Publications Ltd, London, UK2014: 109-122
        • Coenen M
        • Stamm TA
        • Stucki G
        • Cieza A
        Individual interviews and focus groups in patients with rheumatoid arthritis: a comparison of two qualitative methods.
        Qual Life Res. 2012; 21: 359-370
        • Hsieh H-F
        • Shannon SE
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
      7. University of Wisconsin Hospitals and Clinics. Family medicine. Accessed September 26, 2018.

        • Stormo AR
        • Saraiya M
        • Hing E
        • Henderson JT
        • Sawaya GF
        Women's clinical preventive services in the United States: who is doing what?.
        JAMA Intern Med. 2014; 174: 1512-1514
        • Petrin C
        • Kahan S
        • Turner M
        • Gallagher C
        • Dietz W
        Current attitudes and practices of obesity counselling by health care providers.
        Obes Res Clin Pract. 2017; 11: 352-359
        • Norlin C
        • Crawford MA
        • Bell CT
        • Sheng X
        • Stein MT
        Delivery of well-child care: a look inside the door.
        Acad Pediatr. 2011; 11: 18-26
        • Sim LA
        • Lebow J
        • Wang Z
        • Koball A
        • Murad MH
        Brief primary care obesity interventions: a meta-analysis.
        Pediatrics. 2016; 138e20160149
        • Kris-Etherton PM
        • Akabas SR
        • Bales CW
        • et al.
        The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness.
        Am J Clin Nutr. 2014; 99: 1153S-1166S
        • Szucs KA
        • Miracle DJ
        • Rosenman MB
        Breastfeeding knowledge, attitudes, and practices among providers in a medical home.
        Breastfeed Med. 2009; 4: 31-42
        • Fani Marvasti F
        • Stafford RS
        From sick care to health care—Reengineering prevention into the U.S. system.
        N Engl J Med. 2012; 367: 889-891
        • Meedya S
        • Fahy K
        • Kable A
        Factors that positively influence breastfeeding duration to 6 months: a literature review.
        Women Birth. 2010; 23: 135-145
        • Novick G
        • Sadler LS
        • Kennedy HP
        • Cohen SS
        • Groce NE
        • Knafl KA
        Women's experiences of group prenatalcare.
        Qual Health Res. 2011; 21: 97-116
        • Wald HS
        • Anthony D
        • Hutchinson TA
        • Liben S
        • Smilovitch M
        • Donato AA
        Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice.
        Acad Med. 2015; 90: 753
        • Premji K
        • Upshur R
        • Légaré F
        • Pottie K
        Future of family medicine.
        Can Fam Physician. 2014; 60: 409-412
        • Ciliska D
        • Miles E
        • O'brien MA
        • et al.
        Effectiveness of community-based interventions to increase fruit and vegetable consumption.
        J Nutr Educ. 2000; 32: 341-352