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.