Nurturing Care Family Navigator

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.

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.

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 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 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).

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)

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)

The Barriers Needs Assessment Form is a non-validated questionnaire created by the research team to assess perceived barriers to food security such as personal, food, transportation, healthcare, infant, housing, and resource concerns. By systematically identifying perceived barriers, the intervention can implement targeted strategies to address them, such as connecting participants with community resources.The questionnaire was designed with yes/no questions and range from 0 to 52 perceived barriers. Higher scores represent greater perceived barriers. The questionnaire will assess perceived barriers in the intervention and control groups at each time point: baseline T2 (3 months), T3 (6 months), and T4 (12 months).The assessment of perceived barriers will be used to document changes across different time points.

The Self-Efficacy for Food Security Scale is a validated questionnaire designed to assess an individual's confidence in their ability to access and maintain a sufficient and nutritious food supply despite potential challenges. Responses range from 1-4 and they are recorded on a Likert scale ranging from "not at all confident" to "very confident", allowing for an assessment of self-efficacy levels. Higher scares indicate greater self-efficacy: 3-4 indicates high self-efficacy and 1-3 indicates low self-efficacy. The questionnaire will assess both the intervention and control groups at each time point: baseline T2 (3 months), T3 (6 months), and T4 (12 months).The assessment of self-efficacy will be used to document changes across different time points.

Differences in "seeking" behavior assessed by the agency questionnarie at baseline, T2 (3 months), T3 (6 months), T4 (12 months).The perceived agency questionnaire was adapted by the research team. It consists of five questions, and each question is scored on a 3-point scale between 1 and 3. Total scores ranges from 5 to 15. Higher scores indicate greater agency/seeking behavior.

Maternal diet quality reported through the validated Rapid Prime Diet Quality Score Screener (rPDQS).The RPDQS Screener is a brief dietary assessment tool designed to quickly evaluate diet quality based on key food groups associated with health outcomes. It consists of a short questionnaire of 13 questions assessing the consumption of beneficial and harmful food groups and one evaluation of alcohol consumption. The scoring system is a numeric scoring approach that allocates 0 to 4 points to consumption of each of the six food groups whose intake is encouraged (with a reverse scoring for the seven food groups to limit) based on the original frequency of consumption (range, 0-52; higher = healthier).

Total duration of exclusive or partial breastfeeding at enrollment, 3 months, 6 months, and 12 months

Infant feeding quality assessed through the World Health Organization Infant. This questionnaire allows to assess a set of indicators to assess infant and young child feeding.

The Edinburgh Postnatal Depression Scale (EPDS) is a validated to screen for symptoms of postpartum depression (PPD) in new mothers. The EPDS consists of 10 questions assessing emotional well-being over the past seven days. Each question is scored on a 4-point scale between 0 and 3, with total scores ranging from 0 to 30. Higher scores indicate a greater likelihood of depressive symptoms. The scale includes items related to sadness, anxiety, guilt, sleep disturbances, and thoughts of self-harm, making it effective in detecting both symptoms of depression and postpartum anxiety.

Participants will be screened for depression using the Patient Health Questionnaire (PQH-9). The PQH-9 relies on patients self-reporting nine items regarding their health in the past two weeks. Each question is scored from 0 (not at all) to 3 (nearly every day), with a total possible score of 27. A score of 10 or higher will be considered a positive screen for depression.

Participant screened for anxiety using the General Anxiety Disorder-7 (GAD-7). The GAD-7 relies on patients self-reporting seven items regarding their health in the past two weeks. Each question is scored from 0, 1, 2, and 3 to the response categories, respectively, of "not at all," "several days," "more than half the days," and "nearly every day." 0 (not at all) to 3 (nearly every day). GAD-7 total score for the seven items ranges from 0 to 21. Higher scores indicates severity of anxiety symptoms: 0-4: minimal anxiety, 5-9: mild anxiety, 10-14: moderate anxiety, 15-21: severe anxiety.

Participant screened for stress using the Postpartum Stressor Measure. A 9-item scale that measures stress in three areas: baby care, well-being, and work problems. Each question is scored from 0 (not at all) to 4 (very stressful). The score ranges from 9-36. Higher scores reflect higher stress.

Perceived Personal Discrimination in Interactions with Healthcare Providers is a validated self-report questionnaire that measures patients' experiences of discrimination, such as being dismissed, treated with less respect, or receiving lower-quality care. The questionnaire assess seven questions using Likert-scale responses that range from "never" to "always" to gauge the frequency and intensity of discriminatory encounters. The range of possible scores would be 7-35, with a higher number indicating more perceived discrimination.

The "General Social Support: MSPSS" refers to the "Multidimensional Scale of Perceived Social Support" which is a 12-question self-report questionnaire where each question is rated on a 7-point Likert scale, meaning individuals choose a response ranging from "strongly disagree" to "strongly agree" to assess their perceived level of social support from family, friends, and significant others. Higher scores means higher perceived support:12 - 35 Low perceived support, 36-60 Medium perceived support; 61-84 High perceived support. Changes in social support category will be assessed at baseline, T2 (3 months), T3 (6 months), T4 (12 months).

Changes in perceived nutrition environment will be assessed at baseline, T2 (3 months), T3 (6 months), T4 (12 months). Survey items were adapted from the validated Perceived Nutrition Environment Measures Survey (NEM-P). The research team selected 25 items to assess relevant constructs to the intervention: consumer nutrition environment, community nutrition environment, background characteristics, and food shopping behaviors. Higher scores means higher perceived nutrition environment.

Navigated participants' experiences with navigation as assessed through the validated Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) scale. The scale contains 9 items scored as a Likert scale with each item ranging from 1-4. Lower PSN-I total score indicates higher satisfaction.

Program data will be used to quantify the number of referrals made, referrals connected (warm hand-off), and referrals enrolled.

Program data will be used to quantify the number of workshops participants engaged throughout 12 months.

Program data will be used to quantify the number of resources participant is enrolled. The difference in number of resources participant is enrolled from baseline to end of study. A non-validated questionnaire will be used to collect information on resources' enrollment. Resources will be classified in food-related resources enrolled, health-related resources enrolled, and other types of resources enrolled.