Using service-users' views to design a maternal obesity intervention

Abstract

Obesity is increasingly a matter of concern in the general population, but maternal obesity has received limited emphasis compared to adult and childhood obesity. In addition there is a lack of evidence regarding service users' views. A qualitative study was conducted to identify and understand the health-care needs of service users in Lambeth in south-east London. Semi-structured interviews were conducted with six obese pregnant women and three obese women trying to conceive. The lack of awareness of obesity as well as the lack of existing services was acknowledged. The need to develop and implement evidence-based care pathways which focus on improving the identification and management of obesity and include a community-based multi-component, and culturally sensitive intervention was recommended. This feasibility study has highlighted key issues raised by women given the limited evidence of effectiveness around interventions for this target group.

Pregnant women's perceptions of gestational weight gain: A systematic review and meta‐synthesis of qualitative research

“…Women in several studies discuss gestational weight gain as uncontrollable (Garnweidner, Pettersen, & Mosdol, ; Groth & Morrison‐Beedy, ; Groth, Morrison‐Beedy, & Meng, ; Harper & Rail, ; Heery, McConnon, Kelleher, Wall, & McAuliffe, ; Paul, Graham, & Olson, ; Vallianatos et al, ; Weir et al, ) or feeling that weight gain was at the mercy of the physical symptoms of pregnancy (e.g., nausea, fatigue, cravings and aversions, pain, and soreness) (Arden et al, ; Black, Raine, & Willows, ; Furness et al, ; Goodrich, Cregger, Wilcox, & Liu, ; Groth & Morrison‐Beedy, ; Harper & Rail, ; Heery et al, ; Herring, Henry, Klotz, Foster, & Whitaker, ; Olander, Atkinson, Edmunds, & French, ; Paul et al, ; Reyes, Klotz, & Herring, ; Thornton et al, ; Tovar, Chasan‐Taber, Bermudez, Hyatt, & Must, ; Wennberg, Lundqvist, Hogberg, Sandstrom, & Hamberg, ) and the broader circumstances of their lives (e.g., work and family commitments, financial resources, and social pressures) (Black et al, ; Garnweidner et al, ; Groth & Morrison‐Beedy, ; Groth et al, ; Jette & Rail, ; Krans & Chang, ; Reyes et al, ; Thomas et al, ; Thornton et al, ; Vallianatos et al, ). Barriers to healthy weight gain were broad and varied, encompassing beliefs, knowledge, emotional, logistical, practical, social, and structural factors (see Table ), whereas identified facilitators were typically focused on factors related to higher incomes, supportive families, and a trusting relationship with an informative health care provider (Black et al, ; Furness et al, ; Garnweidner et al, ; Goodrich et al, ; Harper & Rail, ; Heery et al, ; Herring et al, ; Khazaezadeh, Pheasant, Bewley, Mohiddin, & Oteng‐Ntim, ; Mills, Schmied, & Dahlen, ; Nyman, Prebensen, & Flensner, ; Paul et al, ; Stringer, Tierney, Fox, Butterfield, & Furber, ; Thornton et al, ).…”

“…There were many knowledge and information barriers related to nutrition, including women who did not understand how to operationalize vague directives to “eat healthy” and women who lack basic cooking skills (Arden et al, ; Furness et al, ; Khazaezadeh et al, ; Reyes et al, ). Nutritional information received at healthcare appointments was described as confusing and constantly changing (Ferrari, Siega‐Riz, Evenson, Moos, & Carrier, ; Furness et al, ; Stringer et al, ; Tovar et al, ; Wennberg et al, ), not culturally relevant (Garnweidner et al, ; Khazaezadeh et al, ; Krans & Chang, ; Paul et al, ), overwhelming (Ferrari et al, ; Furness et al, ; Garnweidner et al, ) , or absent altogether (Duthie et al, ; Furness et al, ; Garnweidner et al, ; Heery et al, ; Jette & Rail, ; Khazaezadeh et al, ; Stringer et al, ; Wennberg et al, ). When nutritional advice was received, it rarely accommodated structural constraints of individual circumstances such as financial hardship or lack of transportation and limited availability of fresh food (Black et al, ; Groth & Morrison‐Beedy, ; Jette & Rail, ; Paul et al, ; Reyes et al, ; Thomas et al, ; Thornton et al, ; Vallianatos et al, ).…”

Gestational Weight Change in Women Attending a Group Antenatal Program Aimed at Addressing Obesity in Pregnancy in New South Wales, Australia

“…In terms of interventions that are acceptable to obese women, several studies have considered preferences for care 37‐40 . These preferences include continuity of care (allowing sensitive issues to be addressed gradually over time), a community location (with an emphasis on health rather than illness), clear and consistent advice and information, 37‐39 access to a variety of health professionals, social support from group sessions, and motivational strategies …”

“…[37][38][39][40] These preferences include continuity of care (allowing sensitive issues to be addressed gradually over time), 38, 39 a community location (with an emphasis on health rather than illness), 37 clear and consistent advice and information, [37][38][39] access to a variety of health professionals, 39 social support from group sessions, 37,39 and motivational strategies. 37 Considering these factors, our specifically designed group antenatal care program may offer an acceptable form of intervention for many obese women in terms of limiting GWG. The integrated nature of the community-based program enabled continuity of care from the same midwives throughout pregnancy and immediate access to a multidisciplinary team.…”

“It’s a Wild Ride”: A Phenomenological Exploration of High Maternal, Gestational Weight Gain

“…Qualitative research on the maternal experience of high gestational weight gain might help health care professionals understand the experience from the perspective of pregnant women, which could, in turn, help inform their counseling efforts. Although peripheral qualitative research has been conducted in this area [13]- [31], the author could not locate a phenomenological study in the literature by the researcher(s) that specifically investigated the entire lived experience of overgaining while pregnant regardless of prepregnancy BMI. The purpose of this study was to explore the whole lived experience of weight gain for pregnant women with high gestational weight gain.…”