A postcolonial feminist discourse analysis of urban Aboriginal women's description of pregnancy-related weight gain and physical activity

Barriers and facilitators to healthy gestational weight gain amongst pregnant women from ethnic minority groups: A systematic search and narrative synthesis

BACKGROUND

Excessive weight gain can be detrimental to the health and wellbeing of both mother and child. There is evidence that women from ethnic minority groups are more likely to gain excessive weight during pregnancy. For the purpose of this review, ethnic minority women are defined as those with different national or cultural traditions from the main population.

AIM

Our aim was to identify barriers and facilitators to healthy gestational weight gain in pregnant women in ethnic minority groups.

METHODS

Databases searched were MEDLINE, CINAHL, PsycInfo and PsycArticles between 2011 and 2022. Inclusion criteria were empirical studies of any method considering gestational weight gain in ethnic minority women published in English. Data were extracted according to aim, participants, methods, and findings in relation to barriers and facilitators. Included papers were assessed for quality according to relevant Joanna Briggs Institute checklists.

FINDINGS

Twenty-six studies were identified. Five themes were revealed: (1) knowledge and beliefs, (2) cultural and social influences, (3) confidence, (4) physical experiences, and (5) personal and environmental factors.

DISCUSSION

Some barriers and facilitators were relevant to all groups and others were more specific to ethnic minority groups. The latter included social and cultural influences, which were reported extensively. Our search was comprehensive, although it is possible we may not have captured all relevant papers.

CONCLUSION

We recommend that the barriers and facilitators identified here are considered in designing future, or adjusting current, health care practitioner mediated interventions to support healthy gestational weight gain in ethnic minority women.

Patient-Defined Cultural Safety in Perinatal Interventions: A Qualitative Scoping Review

Problem

Cultural safety is an approach to patient care designed to facilitate respect of patients' cultural needs and address inequities in care in culturally diverse situations.

Background

Much literature considers culturally safe care during the perinatal period, yet little is known about how patients experience and understand cultural safety. This is despite patient-defined care being one of the definitions of cultural safety.

Question Hypothesis or Aim

This scoping review investigates what is known from existing qualitative literature about patients' experience of cultural safety frameworks in perinatal interventions.

Methods

A search for "cultural safety" OR "culturally safe" in PubMed, Ovid Medline, Ovid Embase, Cumulated Index to Nursing and Allied Health Literature, Scopus, Scielo, and Latin America and the Caribbean Literature on Health Sciences returned 2233 results after deduplication. Title-abstract and full-text screenings were conducted to identify qualitative studies of cultural safety from perinatal patients' perspectives. Seven studies were included in the final analysis. Data were open coded using NVivo.

Findings

Three themes were identified: (1) care that acknowledged that their lives were different from patients in the dominant culture, (2) receiving care in community, and (3) care providers who respected their choices and culturally specific knowledge.

Discussion

This research shows how cultural safety intersects with other equity-based frameworks used in midwifery and obstetrics.

Conclusion

Building on this research could lead to new protocols that address complex social and physical needs of marginalized people during the perinatal period.

Indigenous maternal health and health services within Canada: a scoping review

BACKGROUND

Globally, there are disparities in access to maternal health care services and equity in maternal health outcomes between Indigenous and non-Indigenous populations. While the literature is growing, it has not been systematically synthesized. This review addresses this gap by synthesizing the existing literature on the organizational structure of maternity care, accessibility and delivery of services, and clinical disparities impacting Indigenous maternal health within Canada. It also identifies current knowledge gaps in research on these topics.

METHODS

A scoping review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines and the extension for scoping reviews. The search for relevant papers was performed in PubMed, CINAHL, and SCOPUS electronic databases and included any empirical literature written in English and published during 2006 - 2021. The research team inductively coded 5 articles to develop a coding scheme, which was then applied to the remaining articles.

RESULTS

A total of 89 articles were included in the review, of which 32 were qualitative papers, 40 quantitative, 8 were mixed-methods publications, and 9 were review papers. The analysis of the articles resulted in identifying a range of overarching themes pertaining to the maternal health of Indigenous women within Canada including provision of services, clinical issues, education, health disparities, organization, spatial context, and impact of informal support. The results suggest that physical, psychological, organizational, and systemic barriers inhibit the quality-of-care pregnant Indigenous women receive, and that maternal health services are not consistently provided in a culturally safe manner. Results also suggest that, compared to non-Indigenous pregnant women, Indigenous women are more likely to develop clinical complications during pregnancy, reflecting the structural impacts of colonization that continue to negatively influence Indigenous maternal health and well-being.

CONCLUSIONS

There are many complex barriers that prevent Indigenous women from receiving high quality and culturally appropriate maternal care. Possible areas that could address the service gaps illuminated through this review include the implementation of cultural considerations across health care jurisdictions within Canada.

Children's Influence on Their Parents' Satisfaction with Physical Activity in Nature: An Exploratory Study

Physical activity in nature has several benefits as it is important for good health, offering physical, social, psychological or even ecological benefits. Nevertheless, in order to maintain adherence to this practice, high levels of satisfaction with the practice are necessary. The objective of this study is to explore whether children's characteristics influence parental satisfaction with physical activity in nature, analyzing possible differences according to the gender and age of their children. Two hundred and eighty parents responded to two sociodemographic questions in addition to the Physical Activity Enjoyment Scale (PACES), which consists of 16 items. The normality of the data was determined using the Kolmogorov-Smirnov test. Subsequently, nonparametric tests were used to analyze the variables of gender and age in the items, dimensions and total scores of the questionnaire. Statistical differences were found in some of the positive items, which varied according to the age of the children. However, no significant differences were found in the items with respect to the children's gender or when examining the dimensions or total score of the questionnaire based on both variables. Likewise, age did not show significant correlations with the dimensions and the total score of the questionnaire. Consequently, this study indicates that a child's age may influence parents' positive perceptions of the enjoyment of physical activity in nature. Similarly, the gender of the child does not seem to influence these perceptions.

The stigma associated with gestational diabetes mellitus: A scoping review

BACKGROUND

Gestational diabetes mellitus (GDM) affects an increasing number of pregnant women globally. Although studies have identified psychosocial ramifications associated with GDM, stigma in the form of experienced discrimination and self-blame and its consequences have received limited attention. Our objective was to examine the current evidence on stigma, as experienced among women with GDM, including the potential adverse consequences hereof.

METHODS

A scoping review was conducted with citations retrieved from the databases MEDLINE, CINAHL, EMBASE and, PsycINFO. Studies published before 15 June 2022, when the search was conducted, were included.

FINDINGS

We identified 1388 citations and included 44 in the review. We found that women with GDM may experience stigma in the form of overt discrimination from healthcare personnel and relatives, and in the form of internalised stigma, such as guilt and shame. Identified consequences include avoidance of screening, not following dietary recommendations nor reporting blood glucose readings, social isolation, and poor mental wellbeing. No estimates of stigma prevalence were identified.

INTERPRETATION

Existing evidence shows that women with GDM report stigma, which may affect both their mental and physical health. Further investigations into the prevalence of stigma and long-term consequences of stigma are much needed.

FUNDING

The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

The weight of words: Discursive constructions of health in weight-neutral peer-reviewed journal articles

Weight-neutral approaches to health, like the Health at Every Size® (HAES®) approach arose in response to emerging evidence showing the negative health consequences of weight-focused approaches through the effects of stigma and marginalization in many settings, including healthcare. While the discourses of dominant 'weight-normative' approaches are well-researched and described, little is known about how language and discourse is creating certain 'truths' about weight-neutral approaches. The aim of this study was to explore how academic discourses create truths about weight-neutral approaches to health. A discourse analysis of 63 academic journal articles was conducted. We found that the language used in academic literature is creating confusing and contradictory messages about weight and weight-neutral approaches to health (like the HAES® approach) through: (i) the continued use of stigmatising and normative labels like 'overweight' and 'obese', (ii) paradoxical language like 'flexible restraint', and (iii) a focus on individual responsibility and blame for health and weight without acknowledgement of broader societal and systemic factors. More research is needed to characterize weight-neutral approaches and develop a clearer framework for researchers wishing to engage with the weight-neutral paradigm of health.

Reprint of characterizing gestational weight gain in a cohort of indigenous Australian women

OBJECTIVE

to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index.

DESIGN

analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy.

SETTING

women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program.

PARTICIPANTS

110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child.

MEASUREMENTS AND FINDINGS

measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on pre-pregnancy body mass index, the rate of adequate gestational weight gain in this cohort was low (26%). 33% of women had inadequate weight gain and 41% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (65%), with rates of 39% and 31% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.2, p < 0.01) and hypertension (coefficient 4.3, p = 0.049) were found to be significantly associated with gestational weight gain in mixed model linear regression.

CONCLUSIONS

few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring.

IMPLICATIONS FOR PRACTICE

a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.

Culturally Safe Health Initiatives for Indigenous Peoples in Canada: A Scoping Review

BACKGROUND

Cultural safety has the potential to improve the health disparities between Indigenous and non-Indigenous Canadians, yet practical applications of the concept are lacking in the literature.

PURPOSE

This study aims to identify the key components of culturally safe health initiatives for the Indigenous population of Canada to refine its application in health-care settings.

METHODS

We conducted a scoping review of the literature pertaining to culturally safe health promotion programs, initiatives, services, or care for the Indigenous population in Canada. Our initial search yielded 501 publications, but after full review of 44 publications, 30 were included in the review. After charting the data, we used thematic analysis to identify themes in the data.

RESULTS

We identified six themes: collaboration/partnerships, power sharing, address the broader context of the patient's life, safe environment, organizational and individual level self-reflection, and training for health-care providers.

CONCLUSION

While it is important to recognize that the provision of culturally safe initiatives depend on the specific interaction between the health-care provider and the patient, having a common understanding of the components of cultural safety, such as those that we identified through this research, will help in the transition of cultural safety from theory into practice.

Characterizing gestational weight gain in a cohort of Indigenous Australian women

OBJECTIVE

to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index.

DESIGN

analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy.

SETTING

women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program.

PARTICIPANTS

110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child.

MEASUREMENTS AND FINDINGS

measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on prepregnancy body mass index, the rate of adequate gestational weight gain in this cohort was very low (15%). 32% of women had inadequate weight gain and 54% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (74%), with rates of 48% and 50% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.5, p<0.01) and hypertension (coefficient 4.8, p = 0.04) were found to be significantly associated with gestational weight gain in mixed model linear regression.

CONCLUSIONS

few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring.

IMPLICATIONS FOR PRACTICE

a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.