A qualitative study of the Australian midwives' approaches to Listeria education as a food-related risk during pregnancy

Nutrition education in the midwife consultation room. A cross sectional survey in Spain

BACKGROUND

Diet during pregnancy is a key factor in the success of pregnancy. However, several studies have found pregnant women have low adherence to dietary recommendations. The midwife is a key health professional to provide nutrition education for pregnant women. Thus, it is important to know in detail her role in this respect.

AIM

To explore how Spanish midwives undertake nutrition education in order to assess the need for specific interventions aimed at improving the health of pregnant women.

METHODS

A cross-sectional descriptive observational study was undertaken using an online questionnaire (466 responses).

FINDINGS

Spanish midwives recognise the importance of nutrition in pregnancy and that advising pregnant women in this regard is part of their role. In fact, all community midwives discuss nutrition to pregnant women, although they recognise that they do not feel particularly comfortable in dealing with certain topics, which could be related to a lack of mastery of the subjects. Midwives (56.5 %) rated the nutrition training their received as poor.

CONCLUSION

In order to guarantee the quality in the nutrition education provided by Spanish midwives to promote the health of pregnant women, our results demonstrate the importance of strengthening both the nutrition content of midwives' training programmes and the ongoing support they receive throughout their professional life.

Canadian Midwives' Experiences with Nutrition in Their Training and Practice: A Cross-Sectional Study

INTRODUCTION

Midwives are primary prenatal care providers well-positioned to offer nutrition advice to pregnant individuals; however, no Canadian study has assessed midwives' experience with nutrition education. The objective of this study was to investigate Canadian midwives' experiences with nutrition in their practice, their level of nutrition education, and their recommendations on select nutrition topics.

METHODS

This cross-sectional study used an anonymous online survey consisting of 4 sections: demographics, opinions on the importance of nutrition, nutrition recommendations for pregnancy, and nutrition topics that midwives would like more information on. Responses were recorded using Likert-type scales, multiple choice, or open-ended questions. Eligible participants, registered Canadian midwives, were recruited through advertisements in e-newsletters via national and provincial midwifery associations, social media posts, and emails to midwifery clinics. An independent samples t test compared differences in means for continuous outcomes, the χ2 test compared categorical variables, and the Mann-Whitney U test compared ordinal variables. A P < .05 was considered statistically significant.

RESULTS

In total, 161 midwives completed the online survey. Most midwives (92.5%) indicated that nutrition for pregnancy was important, and 83.2% believed their role in providing nutrition information to pregnant women was important. Almost two-thirds (63.8%) of midwives received nutrition education. Comfort levels were highest (median = 4) when providing nutrition advice on healthy eating, weight gain, Listeria, anemia, heartburn, safe food handling, nutrition for breastfeeding, and weight gain for women with obesity. Almost all the midwives (99.4%) had provided nutrition information to pregnant women, and 85.2% of their recommendations aligned with Canadian guidelines and literature.

DISCUSSION

Canadian midwives valued the importance of nutrition during pregnancy and their role in providing nutrition information to pregnant women. The level of comfort in advising on nutrition ranged from uncomfortable to very comfortable depending on the topic, and most (85.2%) of their advice aligned with Canadian guidelines and relevant literature.

Clinical Outcome and Factors with Dietary Behaviors in Pregnant Women with Listeria monocytogenes: A Hospital-Based Case-Control Study in Shanghai

Listeriosis is a globally rare foodborne disease that causes fetal-placental infection, leading to adverse pregnancy outcome, while limited research among pregnant women is available in China. This study was therefore aimed at analyzing the incidence, clinical manifestations, and clinical outcome of listeriosis among pregnant women and its associated dietary behavior risk factors in prevention. A hospital-based case-control study had been conducted from January 2017 to December 2021. Clinical data, laboratory information, and questionnaires including dietary behaviors and personal hygiene were collected within 2 days after case diagnosis. There were 48 pregnant women, including 12 cases and 36 controls, with an average age of 31.19 ± 3.75 years. The incidence of admission-based listeriosis among pregnant women was 1.6058 per 10,000. The 12 strains were divided into 3 serotypes: 1/2a(83.33%), 1/2b(8.33%), and 4b(8.33%). Among the cases, 5 cases (41.67%) resulted in abortion, 3 cases (25%) induced preterm labor, and 4 cases (33.33%) had full-term deliveries after treatment. There were 7 live births in the case group, among which 6 were admitted to the neonatal intensive care unit (NICU), while 1 case had a healthy fetal outcome. All patients in the control group gave birth to live fetuses. Epidemiological investigation revealed that pregnant women dining at restaurants three or more times per week might increase the risk of having Listeria infection. There were no significant differences in dietary consumed behaviors, hand hygiene, and refrigerator usage behaviors between case and control groups. The study suggested that dining at restaurants might be associated with Listeria infection among pregnant women. Therefore, it is essential to enhance education on listeriosis serious consequences and promote healthy dietary and hygiene habits among pregnant women.

Nutritional awareness of pregnant women and the underlying influencing factors

Nutritional awareness is described as having knowledge or understanding of nutrition. It is often related to the ability of an individual to make an accurate estimate of their food intake, which involves comparing their actual nutritional behavior with the recommended food consumption. Nutritional awareness of women during the various phases of pregnancy may vary significantly across countries due to cultural and lifestyle differences. There has been extensive research on nutritional awareness of pregnant women in selected countries or regions; however, relatively few studies have explored it during different stages of pregnancy. To fill this gap, this article reviews the existing literature and draws together insights into the following areas: changes in nutritional awareness during various phases of pregnancy, nutritional awareness of pregnant women and its underlying factors in various nations, and the research methods used to study nutritional awareness of pregnant women.

Nutritional Education in the Midwife's Consultation Room

Evidence of the importance of maternal nutrition during pregnancy is growing, and midwives are the healthcare professionals in charge of monitoring pregnancy. In the present review, the aim is therefore to look at the relevant contributions on midwifery and the role of midwifery in the provision of nutritional education. Searches were conducted on three databases-Medline, PubMed Central, and Web of Science-using two key search terms ("nutrition" and "midwives") and their synonyms, for an extensive set of results. The final selection consisted of 27 original papers, most of which concerned the nutritional knowledge of midwives, their training, and their views, attitudes, and practices within the field of nutrition. According to the findings, although the midwives considered nutritional education to be part of their role and they agreed on the importance of nutrition during pregnancy, their knowledge of this topic was poor, perhaps due to inadequate nutritional education during their midwifery training. Academic programs on midwifery must therefore be reviewed, so as to increase the workload of nutrition-related subjects, in order to reinforce the corresponding knowledge bases of future midwives. In addition, based on the success of the nutritional interventions discussed in the present review, these sorts of initiatives could be of utmost importance to improve the knowledge of practicing midwives. In any case, it must be highlighted that the available evidence discussed in this review was drawn from only a few countries around the world. Further studies involving midwives of varied origins are therefore needed. Such research would be of immense assistance in the design of the corresponding nutritional interventions in the field, so as to improve the health of pregnant women.

Midwives’ views and experiences of providing healthy eating advice to pregnant women: a qualitative content analysis of semi-structured interviews

Objective

To explore midwives’ views on how they provide healthy eating education to pregnant women after attending a healthy eating education workshop/webinar.

Methods

A qualitative descriptive approach was utilized. Semi-structured interviews were conducted to explore the views and experiences of midwives on providing healthy eating education for pregnant women. A purposive sample of six midwives was interviewed face-to-face, and one was conducted by telephone interview. Data were analyzed through qualitative conventional content analysis.

Results

Midwives described their views and experiences of factors that impacted their role in providing healthy eating education. They identified three categories: perceived role of midwives, health literacy, and model of care.

Conclusions

Knowledge and confidence of midwives improved after attending the workshop/webinar on healthy eating education. Findings suggested that midwives perceived their role as important in providing nutrition education. However, time and resources were highlighted as challenges when providing healthy eating education for pregnant women. The availability of health literacy and model of care were significant factors in enabling midwives to adequately provide this education. Midwives acknowledged a need for further education in areas of vegan diet, cultural food preferences for ethnic minority groups, and regular updates on national healthy eating guidelines.

Links Between Perceptions and Practices in Patient Education: A Systematic Review

Background. Two decades after "patient education" was defined by the World Health Organization, its integration in health care practices remains a challenge. Perceptions might shed light on these implementation difficulties. This systematic review aims to investigate links between perceptions and patient education practices among health care professionals, paying particular attention to the quality of practices in order to highlight any associated perception. Method. PubMed, PsycINFO, and Scopus were searched using the following search terms: "perceptions," "patient education," "health care professionals," and "professional practices." PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used. Results. Twenty studies were included. Overall findings supported the existence of links between some perceptions and practices. Links were either correlational or "causal" (generally in a single direction: perceptions affecting practices). Four types of perceptions (perceptions of the task including patient education, perceptions about the patient, perceptions of oneself as a health care professional, and perceptions of the context) were identified as being linked with educational practices. Links can although be mediated by other factors. Results concerning links should, however, be considered with caution as practices were mostly assessed by prevalence measurements, were self-reported and concerned exclusively individual education. When analyzing the quality of practices, the two retained studies highlighted their changing nature and the central role of perceptions with respect to the individual patient. Conclusions. This literature review led us to specify the quality criteria for further research: covering the entire spectrum of patient education, operationalizing variables, exploring specific practices, measuring the quality of practices, developing designs that facilitate causation findings, and considering a bidirectional perspective.

Listeriosis in Pregnancy: Practitioners' Food Safety Counselling Practices to Pregnant Women

OBJECTIVE

The relative risk of invasive listeriosis in pregnant women is approximately 20 times greater than the general population, and listeriosis during pregnancy can have negative consequences for pregnant women, their fetuses, and their newborns. Health care providers are valuable sources of information, but published data suggest that most providers are unaware of the risk factors for listeriosis or its propensity for pregnant women, and they do not counsel their pregnant patients about risks. The objective of this study was to determine knowledge and practices of Canadian perinatal care providers on food safety counselling to pregnant women.

METHODS

An anonymous bilingual online questionnaire that sought information about awareness, knowledge of risk factors, practices for counselling pregnant women, and practitioners' learning needs with regard to listeriosis was sent to 3199 nurses, midwives, family physicians, and obstetrician/gynaecologists in Canada, with a response rate of 24.4%.

RESULTS

Most respondents had heard of listeriosis, provided prenatal care, and attended deliveries. Rates of awareness of listeriosis were the same among professions and were independent of years in practice, whether practice was urban or rural, and province. One third of the respondents (35.7%) were aware that listeriosis was more common in pregnant women; a minority (18.7%) correctly identified the incubation period for listeriosis and the stage in pregnancy in which women are at highest risk (30.4%). Those respondents who did not counsel women about the risks of listeriosis during pregnancy reported a lack of information or knowledge as the main reason.

CONCLUSION

Advising pregnant women about behaviours and lifestyle habits to prevent infectious diseases remains important, and information about preventive practices needs to be complete and adequate. The health care providers who participated in this study did express a clear need for information related to food safety during pregnancy and listeriosis, as supported by their lack of knowledge in some areas. If that lack is remedied, the knowledge gained could improve counselling practices.

Midwives' Role in Providing Nutrition Advice during Pregnancy: Meeting the Challenges? A Qualitative Study

This study explored the Australian midwives' role in the provision of nutrition advice. Little is known about their perceptions of this role, the influence of the model of care, and the barriers and facilitators that may influence them providing quality nutrition advice to pregnant women. Semistructured telephone interviews were undertaken with a subsample (n = 16) of the members of the Australian College of Midwives who participated in an online survey about midwives' nutrition knowledge, attitudes, and their confidence in providing nutrition advice during pregnancy. Thematic descriptive analysis was used to analyse the data. Midwives believed they have a vital role in providing nutrition advice to pregnant women in the context of health promotion. However, this was not reflected in the advice many of them provided, which in many accounts was passive and medically directed. The extent and efficacy of their role appear to be challenged by many structural barriers. Midwives suggested facilitators that may assist in overcoming these challenges. Midwives need assistance, support, and guidance to provide holistic nutrition advice that assists women to achieve healthy pregnancies. A collaborative approach between midwifery bodies, nutrition and education experts, and maternity care services may provide an effective way forward.

Risk perception in pregnancy: a concept analysis

AIM

To report an analysis of the concept of risk perception in pregnancy.

BACKGROUND

Pregnant women are increasingly exposed to the view that pregnancy and childbirth are intrinsically dangerous, requiring medical monitoring and management. Societal pressures are applied to women that dictate appropriate behaviours during pregnancy. These changes have resulted in increased perception of risk for pregnant women.

DESIGN

Walker and Avant's method was selected to guide this analysis.

DATA SOURCES

Peer-reviewed articles published in English from CINAHL, Scopus, PubMed and Psychinfo. No date limits were applied.

METHODS

Thematic analysis was conducted on 79 articles. Attributes, antecedents and consequences of the concept were identified.

RESULTS

The attributes of the concept are the possibility of harm to mother or infant and beliefs about the severity of the risk state. The physical condition of pregnancy combined with the cognitive ability to perceive a personal risk state is antecedents. Risk perception in pregnancy influences women's affective state and has an impact on decision-making about pregnancy and childbirth. There are limited empirical referents with which to measure the concept.

CONCLUSION

Women today know more about their developing infant than at any other time in history; however, this has not led to a sense of reassurance. Nurses and midwives have a critical role in assisting pregnant women, and their families make sense of the information they are exposed to. An understanding of the complexities of the concept of risk perception in pregnancy may assist in enabling nurses and midwives to reaffirm the normalcy of pregnancy.

Midwives' perception of their role in providing antenatal asthma management in Australia--a qualitative study

International guidelines recommend a collaborative approach to the care of pregnant women with asthma. Midwives, as the primary health care provider for childbearing women should be viewed as collaborative partners in the provision of antenatal asthma management. However, the role of the midwife in providing antenatal asthma management has not been widely reported.

METHOD

Australian midwives' perceived role in antenatal asthma management was studied using a qualitative descriptive method. Semi-structured in-depth interviews were conducted with 13 midwives working in a regional tertiary hospital. Morse and Field's four-stage process was used to analyse the data.

FINDINGS

the perceived role of the midwife in antenatal asthma management varied among participants. Some midwives stated their role was to refer women on to other health professionals. Other midwives stated that they should provide education to the women regarding their asthma management during their pregnancy.

CONCLUSION

participants were uncertain about their role and lacked confidence in antenatal asthma management. The midwifery context in which they worked and the resources available to them at this health care facility appeared to influence the perception of their role.

[Utilization of tacit knowledge by maternal healthcare providers: a systematic mapping of the literature]

INTRODUCTION

The search for efficient answers to strengthen maternal health care has included various sources of evidence for decision making. In this article, we present a systematic mapping of the scientific literature on the use of tacit knowledge in relation to maternal healthcare.

METHODS

A systematic mapping was conducted of scientific articles published in Spanish and English between 1971 and 2014 following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

RESULTS

Of 793 articles, 30 met the inclusion criteria; 60% were from high-income countries and 66.7% were focused on health professionals. We identified a predominance of qualitative methodologies (62%). Four categories regarding the use of tacit knowledge were generated: proposals to improve the organization of the maternal care system (30%) and to improve the care provided to women during the continuum of pregnancy, childbirth and postpartum (26.7%), determination of health workers' perception and skill levels (26.7%) and the interactions between tacit and explicit knowledge in clinical decision making (16.7%).

CONCLUSIONS

This mapping shows that tacit knowledge is an emerging, innovative and versatile research approach used primarily in high-income countries and that includes interesting possibilities for its use as evidence to improve maternal healthcare, particularly in middle- and low-income countries, where it needs to be strengthened.

Midwives and nutrition education during pregnancy: a literature review

OBJECTIVES

This review explored the extent to which the role of midwives in nutrition education during pregnancy has been reported in the literature and areas requiring further research were identified.

REVIEW METHOD

A review of the literature was undertaken. Articles included in the review were published in English, in scholarly journals, and provided information about the knowledge, education, and attitudes of midwives towards nutrition during pregnancy.

RESULTS AND DISCUSSION

Few studies were identified. The included studies were exploratory and descriptive. Studies had reported that midwives lacked a basic knowledge of nutrition requirements during pregnancy. This might be attributed to inadequate nutrition education provided in both undergraduate and postgraduate midwifery programmes. The nutrition education components of midwifery courses were not identified within the studies reviewed.

CONCLUSION

Limited international or Australian research is available that reports on the role of midwives in nutrition education during pregnancy and the nutrition content of midwifery curricula. This represents an important omission in midwives capacity to support the health of pregnant women and their babies. More research is required to explore the educational needs of midwives to enhance nutritional care for pregnant women.