Food-based nutrition counselling and education intervention for improved diets of pregnant women in rural Malawi: a qualitative study of factors influencing dietary behaviour change

Effects of Nurse-Led e-Health Interventions on the Health-Related Outcomes of Pregnant Women: A Systematic Review

BACKGROUND

Pregnancy is a special time for women that involves substantial emotional, physical, social, and family changes, which can lead to physical and psychological harm. The rapid development of e-health has provided a favourable platform for managing health-related outcomes in pregnant women, and nurses are the professional group that is most likely to provide e-health services. Nurse-led e-health interventions have attracted increasing attention, but their effects are uncertain.

OBJECTIVE

To identify the effectiveness of nurse-led e-health interventions in improving health-related outcomes in pregnant women.

DESIGN

A systematic review.

DATA SOURCES

The PubMed, PsycINFO, EMBASE, CINAHL, ProQuest, MEDLINE, Scopus, Web of Science and Cochrane Library databases were searched from inception to March 2023.

METHODS

Two reviewers independently assessed study eligibility and extracted data. The Cochrane risk of bias tool was used for quality assessment. The findings of this review are presented using a narrative synthesis.

RESULTS

This review included 14 studies involving 2016 participants. Three out of five studies reported that nurse-led e-health interventions significantly reduced depressive symptoms. Four studies reported significant improvements in stress and self-efficacy after the intervention. Two studies reported significant improvements in anxiety symptoms, self-management ability, and quality of life after the intervention. One study showed that weight gain and physical activity significantly improved after the intervention. Due to the heterogeneity in the included studies, no meta-analysis was conducted.

CONCLUSIONS

Nurse-led e-health interventions may be beneficial for improving anxiety symptoms, depressive symptoms, stress, self-efficacy, weight gain, self-management ability, physical activity, and quality of life in pregnant women.

RELEVANCE TO CLINICAL PRACTICE

Nurse-led e-health interventions could provide individualised, economic, interactive, and convenient nursing modes for pregnant women. Rigorous and high-quality evidence confirming the long-term effects of these interventions on pregnant women is necessary.

NO PATIENT OR PUBLIC CONTRIBUTION

The patients had no direct involvement in the present study.

REGISTRATION NUMBER

PROSPERO registration ID: CRD42023401973.

Dietary knowledge, attitude, practice, and associated factors among pregnant mothers in Ethiopia: a systematic review and meta-analysis

Background

Despite global efforts, progress in reducing maternal malnutrition falls short of international goals, which is the same for Ethiopia, provided that studying dietary knowledge, attitude, and practice and their determinants is crucial to developing and implementing effective interventions, which this review tried to investigate in an Ethiopian context.

Methods

We searched on Scopus, HINARI, PubMed, and Google Scholar on January 3, 2024. We used the Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. Certainty was assessed using sensitivity and subgroup analyses and the Luis Furuya-Kanamori (LFK) index. The random effects model was used to determine the effect estimates with a p value less than 0.05 and a 95% CI.

Results

The pooled good dietary knowledge, favorable attitude, and good practice were 48.0% (95% CI: 39.0-57.0%), 47.0% (95% CI: 38.0-55.0%), and 34.0% (95% CI: 28.0-40.0%), respectively. Knowledge and attitude had bidirectional relationships and were affected by sociodemographic variables and gynecological issues. The dietary practice was influenced by urban residency (OR = 6.68, 95% CI: 2.49-10.87), food security (OR = 3.51, 95% CI: 1.02-5.99), knowledge (OR = 4.53, 95% CI: 3.22-5.74), nutrition information (OR = 3.07, 95% CI: 1.13-5.02), attitude (OR = 2.32, 95% CI: 1.34-3.30), family support (OR = 2.14, 95% CI: 1.43-2.85), perceived severity of malnutrition (OR = 2.07, 95% CI: 1.82-2.31), and positive perception of dietary benefit (OR = 2.19, 95% CI: 1.56-2.82).

Conclusion

The good dietary practice was lower than the knowledge and the favorable attitude toward it. It was influenced by sociodemographic variables, income and wealth, knowledge and information, attitudes and intentions, gynecological and illness experiences, family support and decision-making, and expectations of nutrition outcomes and habits. Sociodemographic and gynecological issues were also found to influence both dietary knowledge and attitude, which were also found to have bidirectional relationships.Systematic review registration: PROSPERO identifier: CRD42023440688.

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.

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review

Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.