Exploring strategies to strengthen patient-provider interactions and communication during prenatal care visits remains critical to address for facilitating continuity of care for mothers of color. These findings warrant further investigation of dual patient and provider perspectives of culturally sensitive prenatal care to address the service needs of African American and mixed race mothers.
Objective Examine factors implicated in gestational weight gain (GWG) in low-income overweight and obese women. Design Qualitative study. Setting Community-based perinatal center. Participants 8 focus groups with women (Black=48%, White non-Hispanic=41%, Hispanic=10%) in the first half of (n=12) and last half of pregnancy (n=10), or post-partum (n=7); 2 with obstetrician-gynecologists (OB-GYNs) (n=9). Phenomenon of Interest Barriers and facilitators to healthy eating and GWG within different levels of the Social Ecological Model (SEM), e.g. intrapersonal, interpersonal, organizational, etc. Analysis Coding guide was based on the SEM. Transcripts were coded by 3 researchers for common themes. Thematic saturation was reached. Results At an intrapersonal level, knowledge/skills and cravings were the most common barriers. At an interpersonal level, family and friends were most influential. At an organizational level, the Women, Infants, and Children (WIC) program and clinics were influential. At the community level, lack of transportation was most frequently discussed. At a policy level, complex policies and social stigma surrounding WIC were barriers. There was consensus that ideal intervention approaches would include peer-facilitated support groups with information from experts. OB-GYNs felt uncomfortable counseling patients about GWG due to time constraints, other priorities, and lack of training. Conclusions and Implications There are multi-level public health opportunities to promote healthy GWG. Better communication between nutrition specialists and OB-GYNs is needed.
Objectives The purpose of this study was to test the effectiveness of an intervention to improve the consistency and accuracy of antenatal gestational weight gain counseling through introduction of a “best practice alert” into an electronic medical record (EMR) system. Methods A best practice alert was designed and implemented in the EMR. Based on each patient’s pre-gravid body mass index, fetal number, and 2009 Institute of Medicine guidelines, the alert provides an individualized total gestational weight gain goal, the weight gain goal per week of gestation, a template for scripted provider counseling and documentation, and a patient handout containing personalized gestational weight gain information. Retrospective chart reviews of 388 pre-intervention patients and 345 post-intervention patients were used to evaluate effectiveness. Results Introduction of a gestational weight gain best practice alert into the EMR improved the rate of antenatal gestational weight gain counseling that was consistent with current Institute of Medicine guidelines (p<0.001). Improvement in IOM-consistent gestational weight gain counseling was seen across all provider types, including obstetricians, family practice physicians, and certified nurse midwives. The intervention also resulted in significant improvement in documentation of pre-gravid weights and BMIs within the EMR. Conclusions The EMR is an effective tool for improving the consistency and accuracy of antenatal gestational weight gain counseling in accord with 2009 Institute of Medicine guidelines.
Objective To examine whether an electronic medical record “best practice alert” previously shown to improve antenatal gestational weight gain patient education resulted in downstream effects on service delivery or patient health outcomes. Methods This study involved secondary analysis of data from an intervention to improve provider behavior surrounding gestational weight gain patient education. Data were from retrospective chart reviews of patients who received care either before (N=333) or after (N=268) implementation of the intervention. Pre-post comparisons and multivariable logistic regression were used to analyze downstream effects of the intervention on health outcomes and obesity-related health services while controlling for potential confounders. Results The intervention was associated with an increase in the proportion of prenatal patients who gained weight within Institute of Medicine guidelines, from 28% to 35% (p < .05). Mean total gestational weight gain did not change, but variability decreased such that post-intervention women had weight gains closer to their gestational weight gain targets. The intervention was associated with a 94 gram decrease in mean infant birth weight (p = .03), and an increase in the proportion of overweight and obese women screened for undiagnosed Type 2 diabetes before 20 weeks gestation, from 13% to 25% (p = .01). Conclusions for Practice The electronic medical record can be leveraged to promote healthy gestational weight gain and early screening for undiagnosed Type 2 diabetes. Yet most patients still need additional support to achieve gestational weight gain within Institute of Medicine guidelines.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.