In this study, community collaboration in providing nutritional guidance was strongly related to the implementation of a multi-professional meetings after health checks (post-conferences). This finding is consistent with previous reports in which sharing information among staff enabled professionals to both create a shared vision, strong leadership, and broad collective goals and to clarify strengths and priorities for developing and launching projects [
20]. The importance of selecting the most appropriate approach to create a collaboration has been reinforced by health data and reliable information showing the results of environmental and behavioral change [
21]. If staff are unable to share child health information, then it will be unclear whether a particular response or approach is appropriate [
22]. It is necessary to confirm why some municipalities do not conduct post-conferences. Post-conferences may help to establish a better system for health checks and nutritional improvement for infants.
Multidisciplinary collaboration for nutritional support in the community
In Japan, health checks are used to make an accurate assessment of the needs of infants and their parents. Parents may continue to experience difficulties and require support throughout their child’s early years [
2,
16]. It is therefore important to establish a system that enables continuous support of infants and parents in the community [
2,
21,
23].
According to Japan’s national infant nutritional survey, an unbalanced diet (including snacks and soft drinks) leads to dietary issues in children. The proportion of children with such diets is significantly higher in low-income households [
16]. Other studies have reported a relationship between the consumption of sugary drinks and poor eating behavior among infants and children [
24‐
26].
One of the main objectives of community collaboration is to monitor the progress of infants and parents who require particular support in certain areas, including nutrition [
21]. A multi-sectorial approach is required to address various dimensions of maternal and child healthcare, including environmental health [
27].
Health professionals such as dietitians can then be involved in deciding whether further assistance is necessary or whether the issues have been resolved with the support provided [
2,
5]. It is important that staff from multiple health disciplines and community groups are involved in discussions about infants and parents at post-conferences, as this involvement enables a consensus on the need for monitoring, continued support, or follow-up evaluations with home visits [
6,
23].
This study found that the factors strongly related to community collaboration in providing nutritional guidance included sharing information about infant dental checkups and the results of follow-up activities before children entered elementary school. Sharing this information will lead to ongoing support throughout the child’s education [
10]. The life course perspective is a critical addition to this work: it highlights the importance of ensuring that infants and children live in supportive community environments that will foster optimal health, development, and well-being throughout their lives [
3,
7].
It is important to develop long-term support systems for infants and parents by sharing information, especially about food and nutrition, between community organizations such as nursery schools, pediatric clinics, kindergartens, child welfare facilities, associations for the promotion of better dietary habits, community cafeterias for children, and other governmental and non-governmental organizations [
10].
This study had some limitations. First, its cross-sectional design suggests that no causal relationships can be inferred, such that reverse causation or simple correlation could account for the observations. Second, the final response rate of 56.7% was relatively low. The questionnaire was not administered to individuals, and it covered a broad range of disciplines; moreover, staff operating in different fields may have responded differently to certain items. Local government staff may also have the lacked time to complete the questionnaire during working hours and, in particular, to obtain a consensus from other staff members. Characteristics of municipalities that did not respond (around one third in total) were almost the same as those that did, including population size (small, medium and large population). One of the reasons why some municipalities did not respond may have been because that they have no full-time staff in charge of nutrition. During the study period, several municipalities responded to explain that they only had part-time staff responsible for nutritional guidance, so could not cooperate. In future surveys, it will be necessary to consider the investigation method to ensure that municipalities are not excluded because of the employment situation of staff in charge of providing nutritional guidance. Responses to the survey may also have been limited to municipalities that actively conduct health checks. A follow-up study using face-to-face interviews with health workers should be considered. Fourth, our analysis was restricted to items that could apply to all municipalities. Future investigations should examine whether the response options are unique to Japan. Municipal income was not included as a confounding factor in this survey, but should be included in a future study.
Despite these limitations, this study found relationships between community collaboration in providing nutritional guidance and the implementation of post-conferences, the follow-up evaluation of children suspected of having developmental and mental difficulties before they enter elementary school, and the use of dental checkup results in health guidance for parents and their children. The results of this study are significant because very few studies to date have examined the links between nutritional guidance and infant health checks.