Self-Reported Nutrition Education Received by Australian Midwives before and after Registration

Unveiling the Craving: A systematic review of pregnant women's desires for expert nutrition care in Australia

PROBLEM

Poor nutrition during the antenatal period can contribute to adverse health outcomes for both mother and baby.

BACKGROUND

Despite the importance of nutrition during pregnancy, there is limited research exploring the attitudes and experiences pregnant women possess towards nutrition care, particularly within the Australian context. Existing literature has indicated that pregnant women lack knowledge of and are not adhering to pregnancy related nutrition recommendations. Furthermore, although pregnant women rely on many health professionals for nutrition care, there are deficiencies in both the quality and quantity of care provided.

AIM

The aim of this meta-aggregative review was to explore the experiences and attitudes pregnant women in Australia have towards nutrition care.

METHODS

Meta-aggregation was used to synthesise qualitative studies. A search strategy was applied to four electronic databases in May 2023.The findings were extracted and synthesised via the JBI approach.

FINDINGS

A total of 719 studies were identified in the initial database search with seven eligible studies included in the meta-aggregation. From 11 categories, three synthesised findings were developed: (i) approaches to nutrition care delivery matters, (ii) quality and quantity of nutrition care is insufficient, and (iii) pregnant women value nutrition care.

CONCLUSION

This review highlights pregnant women's desires for better nutrition care in Australia, with current provision of nutrition care lacking in quality and quantity. Improved antenatal dietetics services and increased health professional nutrition training is necessary to address these concerns.

Nutrition knowledge and practice of midwives in Botswana

Background

The roles and responsibilities of midwives include providing adequate nutrition assessment, nutrition and health education, counselling, and support to pregnant women.

Aim

This study aims to assess midwives' nutrition knowledge and to what extent they integrate maternal nutrition in services provided at health facilities.

Setting

This study included hospitals and clinics within the three selected districts in Botswana.

Methods

A cross-sectional study design with an analytical component was employed. Direct observation through a checklist and a structured interviewer-administered questionnaire were used. Data were analysed using SPSS IBM version 26.

Results

A sample of 102 midwives participated, resulting in a response rate of 82%. Most of the participants were females (89.2%). Maternal nutrition knowledge was found to be variable but decreased with midwives' age. A statistically significant correlation coefficient of p < 0.005 at r = -0.278 was observed between maternal nutrition knowledge and age. Similarly, there was a statistically significant negative correlation between maternal nutrition knowledge, practices and maternal nutrition course attended using Pearson correlation (r = -0.217 p < 0.028).

Conclusion

Midwives had adequate to variable but declining maternal nutrition knowledge and practices with age. There is a need to provide midwives with refresher courses, as their nutrition knowledge and practices were related with courses attended.

Contribution

The study contributes to provide the literature concerning nutrition knowledge and practices of midwives. The results will assist in addressing the gaps encountered and lead to the improvement of maternal nutrition and pregnancy outcomes.

A prospective observational evaluation of an online health care professional training program to promote healthy pregnancy weight gain

ISSUE ADDRESSED

A lack of programs to develop clinician knowledge and confidence to address weight gain within pregnancy is a barrier to the provision of evidence-based care.

AIM

To examine the reach and effectiveness of the Healthy Pregnancy Healthy Baby online health professional training program.

METHODS

A prospective observational evaluation applied the reach and effectiveness elements of the RE-AIM framework. Health professionals from a range of disciplines and locations were invited to complete questionnaires before and after program completion assessing objective knowledge and perceived confidence around aspects of supporting healthy pregnancy weight gain, and process measures.

RESULTS

There were 7577 views across all pages over a year period, accessed by participants across 22 Queensland locations. Pre- and post- training questionnaires were completed 217 and 135 times, respectively. The proportion of participants with scores over 85% and of 100% for objective knowledge was higher post training (P ≤ .001). Perceived confidence improved across all areas for 88%-96% of those who completed the post- training questionnaire. All respondents would recommend the training to others.

CONCLUSIONS

Clinicians from a range of disciplines, experience and locations accessed and valued the training, and knowledge of, and confidence in delivering care to support healthy pregnancy weight gain improved after completion. SO WHAT?: This effective program to build the capacity of clinicians to support healthy pregnancy weight gain offers a model for online, flexible training highly valued by clinicians. Its adoption and promotion could standardise the support provided to women to encourage healthy weight gain during pregnancy.

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.

Pregnancy nutrition knowledge of antenatal care providers: An evaluation of an online training module

BACKGROUND

Nutrition education for clinicians providing pregnancy care has the potential to enhance pregnant women's diet quality, leading to healthier outcomes for mother and baby. Following a study demonstrating nutrition knowledge gaps, an online training module was developed, implemented, and evaluated.

METHODS

Antenatal care providers completed a pregnancy nutrition knowledge questionnaire to assess knowledge levels at baseline (n = 97) and nine months after the introduction of online training (n = 64).

FINDINGS

Knowledge scores at baseline and post-training implementation were not significantly different. Sub-group post-training knowledge scores between clinicians who completed the training module was higher than for those that did not complete the training module. User experience of the training module was positive and they felt it was useful in enhancing nutrition knowledge. Just under half of clinicians felt more confident in providing nutrition advice as part of their pregnancy care. Clinicians reported that time constraints prevented them from completing the nutrition training and/or providing nutrition education. Despite the positive experience of completing the online training module, a majority of clinicians surveyed indicated they preferred face-to-face training.

CONCLUSION

Further research exploring how nutrition is prioritised in antenatal appointments and how knowledge levels influence nutrition education practices is needed.

A review of current knowledge about the importance of iodine among women of child-bearing age and healthcare professionals

Iodine is required for thyroid hormone synthesis and fetal neurogenesis. Recent population studies in the United Kingdom (UK) have found iodine deficiency among schoolgirls, women of child-bearing age and pregnant women. This review explores knowledge and awareness of iodine among women of child-bearing age and healthcare professionals (HCPs) in the UK, set within a global context. We aimed to identify gaps in iodine knowledge in the current UK setting of iodine deficiency without iodine fortification and where iodine is not included in antenatal guidelines. The search terms ‘iodine knowledge’ and ‘iodine awareness’ were used to identify relevant papers. Iodine knowledge is poor among women of child-bearing age in the UK according to four studies using questionnaires and qualitative methods. They were unsure of dietary sources of iodine and were not consistently provided with relevant information from HCPs during clinical care. Midwives have been recognised as the main providers of dietary information during pregnancy and, although they recognised the importance of their role in providing nutrition advice, they did not feel equipped to do so and lacked confidence in addressing nutritional concerns. Globally, there was a similar lack of knowledge, however, this was somewhat improved by the inclusion of iodine in antenatal care guidelines. Midwives’ knowledge of iodine was poor, as was knowledge among women of child-bearing age. Improved HCP knowledge and effective communication of information to pregnant women and women planning to conceive may help to improve iodine status which is of particular concern in pregnancy.

A review of primary healthcare practitioners' views about nutrition: implications for medical education

OBJECTIVES

This study aimed to review literature that reports on the perspectives and opinions of Australian and New Zealand primary healthcare practitioners on their role in nutrition counselling of their patients.

METHODS

A systematic search of relevant articles reporting on attitudes towards nutrition counselling by Australian and New Zealand doctors/physicians, nurses including midwives, pharmacists and dentists was conducted. The search included literature from the past ten years until March 2021 and identified 21 relevant papers, with most of the studies including medical practitioners and nurses.

RESULTS

Three main themes were identified from qualitative and quantitative data, which included education and training, practitioner experiences and challenges. Consistent with previous literature, health care practitioners acknowledged their important role in the provision of dietary advice to patients. Challenges that influenced the provision of this advice included insufficient education and training, time constraints and limited knowledge and confidence. Time constraints during normal consultations led to a low priority of nutrition counselling. An absence of assessment opportunities to demonstrate nutrition competence and limited coverage of specific nutrition-related advice during training were also reported.

CONCLUSIONS

Primary healthcare practitioners acknowledge the importance of playing a role in the provision of nutrition advice but require education and access to evidence-based information that can be utilised effectively within the time constraints of standard consultations. Medical education curricula can be improved to provide more emphasis on nutrition education, including relevant assessment opportunities.

The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy

Women with maternal obesity, an unhealthy lifestyle before and during pregnancy and excess gestational weight gain have an increased risk of adverse pregnancy and birth outcomes that can also increase the risk of long-term poor health for them and their children. Pregnant women have frequent medical appointments and are highly receptive to health advice. Healthcare professionals who interact with women during pregnancy are in a privileged position to support women to make lasting healthy lifestyle changes that can improve gestational weight gain and pregnancy outcomes and halt the intergenerational nature of obesity. Midwives and obstetrical nurses are key healthcare professionals responsible for providing antenatal care in most countries. Therefore, it is crucial for them to build and enhance their ability to promote healthy lifestyles in pregnant women. Undergraduate midwifery curricula usually lack sufficient lifestyle content to provide emerging midwives and obstetrical nurses with the knowledge, skills, and confidence to effectively assess and support healthy lifestyle behaviours in pregnant women. Consequently, registered midwives and obstetrical nurses may not recognise their role in healthy lifestyle promotion specific to healthy eating and physical activity in practice. In addition, practising midwives and obstetrical nurses do not consistently have access to healthy lifestyle promotion training in the workplace. Therefore, many midwives and obstetrical nurses may not have the confidence and/or skills to support pregnant women to improve their lifestyles. This narrative review summarises the role of midwives and obstetrical nurses in the promotion of healthy lifestyles relating to healthy eating and physical activity and optimising weight in pregnancy, the barriers that they face to deliver optimal care and an overview of what we know works when supporting midwives and obstetrical nurses in their role to support women in achieving a healthy lifestyle.

Healthcare Professional Training Regarding Gestational Weight Gain: Recommendations and Future Directions

PURPOSE OF REVIEW

The aim of this review was to summarise recent evaluations of healthcare professional training regarding gestational weight gain and provide recommendations for future training.

RECENT FINDINGS

A number of evaluated healthcare professional training sessions regarding gestational weight gain show promising results in terms of increased participant confidence and knowledge and impact on women's outcomes. It is clear that the interventions which have also implemented resources in the practice environment to support training are the ones most likely to influence gestational weight gain. Support from healthcare professionals are key to influence pregnant women's weight gain and should be offered within the standard curriculum and through mandatory training. Factors influencing this support include women's and healthcare professional characteristics, interpersonal and healthcare system and policy factors. All of these need to be considered when developing healthcare professional training to support women with their gestational weight gain.

Pregnant Women Have Poor Carbohydrate Knowledge and Do Not Receive Adequate Nutrition Education

OBJECTIVES

In order to manage blood glucose levels in pregnancy, women need to know what and how much to eat, particularly for foods containing carbohydrate. The aim was to assess pregnant women's carbohydrate and standard serve size knowledge and examine whether health professionals provided nutrition education.

METHODS

Between July 2017 and April 2018 Australian pregnant women were recruited to complete an online survey, including a modified PedCarbQuiz carbohydrate knowledge questionnaire and an online buffet, where they selected images equivalent to one Australian Guide to Healthy Eating (AGHE) standard serve size.

RESULTS

186 pregnant women (mean age 30.9 years, SD = 4.7 years) 12-22 weeks gestation completed the survey. Participants achieved a median score of 27/36 for identification of carbohydrate-containing foods and a median score of 1/12 (range 0-11) for identification of grams of carbohydrate in specific portions. Participants achieved a median score of 14/22 (range 4-19) for identification of one AGHE standard serve of 11 carbohydrate-containing foods. Less than half (n = 92, 49.5%) received nutrition education from health professionals.

CONCLUSIONS FOR PRACTICE

Pregnant women had sub-optimal carbohydrate knowledge. This could contribute to impaired blood glucose concentrations and risk of adverse health outcomes in pregnancy. Opportunities for pregnant women to access nutrition advice from health professionals should be explored.

Effect of nutrition education by health professionals on pregnancy-specific nutrition knowledge and healthy dietary practice among pregnant women in Asmara, Eritrea: a quasi-experimental study

Background

Healthy pregnancy and birth outcomes are greatly influenced by the intake of adequate and balanced nutrition. Pregnant women's nutritional knowledge and practice have been identified as an important prerequisites for their proper nutritional intake. The antenatal period with the opportunities for regular contact with health professionals appears to be the ideal time and setting to institute the intervention which could maximise pregnant women's outcome and that of their baby by motivating them to make nutritional changes.

Objective

To assess the effect of nutrition education on the appropriate nutritional knowledge and practice of pregnant women.

Methodology

A facility-based single-group pre-post quasi-experimental study design was employed in five health facilities providing antenatal care (ANC) service in Asmara on 226 pregnant women. A predesigned and pretested questionnaire was used to collect data regarding nutritional knowledge via interview by trained data collectors during the pretest, immediate post-test and 6 weeks later. The practice was assessed at pre-intervention and 6 weeks later only. Repeated measures analysis of variance and paired t-test were used to make comparisons in knowledge and practice scores, respectively, using SPSS (V.22).

Results

Training provided to pregnant women resulted in a significant increase on the mean scores of their knowledge from 29.01/47 (SE=0.35) pre-intervention to 42.73/47 (SE=0.24) immediate post-intervention. However, the score declined significantly from immediate after intervention to 6-week follow-up by 1.79 (SE=0.22). Although the score declined, knowledge at 6-week follow-up was still significantly greater than that of pre-intervention (p<0.0001). Health professionals (70.2%) were the primary source of information for pregnant women. The pregnancy-specific dietary practice score at 6-week follow-up (M=13.13/16, SE=0.09) was significantly higher than that of pre-intervention (M=12.55/16, SE=0.16). There was no significant interaction between the categories of demographic characteristics and change in practice and knowledge.

Conclusion

This study has shown that the nutrition messages given to pregnant women by trained health professionals using a holistic approach in a sustained manner played a huge role in increasing their knowledge and in introducing positive dietary practices among them. Thus, ANC clinics must play a leading role in coordinating the effort of awareness creation regarding nutrition during pregnancy.

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.

Weight management across pregnancy and postpartum care: The need for interprofessional education and collaboration

The journey from pregnancy to caring for a new infant is a significant experience for many women and crucial period for obesity prevention. During this time, a large portion of care is allocated to midwives and maternal and child health nurses (MCHN). These professions have the potential to play a crucial role in supporting women with weight management across pregnancy and postpartum; however, both midwives and MCHNs report barriers to doing this. Upskilling achieved through midwifery and MCHN education that equips midwives and MCHNs with the skills and knowledge to provide evidence-based advice for weight management could assist in addressing some of these barriers. Interprofessional collaboration should be fostered so healthy lifestyle messages and support are reinforced consistently by midwives and MCHNs throughout pregnancy and postpartum.

Feasibility of face-to-face and online learning methods to provide nutrition education to midwives, general practice nurses and student nurses

Midwives and general practice nurses are ideally positioned to provide nutrition education to pregnant women. However, it appears that they do not receive sufficient nutrition training to enable them to fulfil this role. This study aimed to develop, implement and evaluate a suite of learning resources developed specifically for midwives, general practice nurses and student nurses. A four-module suite of learning resources was developed based on recommendations in the Australian Antenatal Care Clinical Guidelines as well as formative evaluation with stakeholders. The feasibility of these modules was tested using a pre-test and post-test quasi-experimental design with three arms using convenient sampling (face-to-face with midwives; online with student nurses; and online with midwives, nurses and practice nurses). Completion rates across the three study arms were poor (n=40 participants in total). For the combined data, there was a significant increase in knowledge scores across all modules from the pretest score (median (IQR): 3.46 (2.09–4.13)) to the post-test score (5.66 (4.66–6.00)) (p<0.001). Studies of high quality are required to determine if changing the nutrition knowledge and confidence in delivering nutrition care of health professionals results in sustainable changes to their clinical practice.