Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy

Access to nutrition advice and knowledge, attitudes and practices of pregnant women in Ireland: A cross-sectional study

BACKGROUND

Healthy nutritional status, appropriate gestational weight gain and a balanced diet are important predictors of perinatal health outcomes. However, gaps exist in the translation of nutrition recommendations into dietary practices of women before and during pregnancy. The present study explored the relationship between access to nutrition advice, nutrition knowledge, attitudes and practices among pregnant women.

METHODS

Pregnant women aged > 18 years in Ireland were eligible to complete a self-administered survey consisting of four subsections (demographics, nutrition knowledge, attitudes and practices) delivered online through Qualtrics.

RESULTS

In this convenience sample (n = 334, median [interquartile range] gestation, 25.0 [16.0, 34.0] weeks), 85% had at least an honours bachelor degree and 88.9% planned their pregnancy. Two out of five women received nutrition advice during their pregnancy, mostly from a midwife. Based on the percentage of correct answers (of 15 questions), women with previous nutrition education (e.g., school home economics) had better median [interquartile range] nutrition knowledge than those with none (80.0% [66.7, 86.7%] vs. 73.3% [60.0, 80.0%], p < 0.001). Those who received nutrition advice during pregnancy did not score higher than those who did not (73.3% [66.7, 80.0%] vs. 73.3% [66.7, 80.0%], p = 0.6). Over three-quarters of participants considered nutritional supplement use to be very or extremely important. Although 73.6% and 92.4% took supplements prior to and during pregnancy, only 25.7% reported compliance with periconceptional folic acid supplementation guidelines. Half of respondents considered healthy eating during pregnancy as very or extremely important.

CONCLUSIONS

Access to nutrition advice during pregnancy was inadequate with poor nutrition knowledge, attitudes and practices observed. Accessible, evidence-based nutrition education for women prior to and during pregnancy is required.

Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial

Background

Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM.

Aims

This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care.

Methods

Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval.

Discussion

This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM.

Clinical trial registration

https://clinicaltrials.gov/study/NCT05299502, NCT05299502.

A pilot randomized controlled trial of a lay telephone coaching and web-based intervention for postpartum depression and anxiety: The MPOWER study

BACKGROUND

Mental health problems are frequent in the postpartum period, but accessible treatment options are lacking. The MPOWER study investigated whether the use of trained lay coaches could increase the uptake and effectiveness of a web-based intervention (WBI) for women with postpartum depression and/or anxiety.

OBJECTIVES

First, to compare the feasibility and acceptability of a WBI for women with postpartum depression and anxiety, with and without the addition of telephone coaching calls. Second, to estimate the effectiveness of the WBI at decreasing symptoms of depression and anxiety at 6 months, with and without coaching calls.

METHODS

We conducted a pilot randomized controlled trial (RCT) that enrolled women who had recently given birth and had mild to moderate postpartum depression and/or anxiety. Study participants were provided access to the WBI. Women randomized to the intervention group also received up to 7 telephone coaching calls during the 6 months of follow up. We evaluated the feasibility of the intervention through participants' usage of the WBI, as well as the completion and fidelity of planned coach calls. We measured acceptability via two questionnaires on the usability of the WBI and participant satisfaction with the intervention. To determine the potential effectiveness of the intervention, the primary outcomes were defined as symptoms of depression and anxiety at 6 months and adjusted mean differences between groups for these outcomes were estimated using linear regression models.

RESULTS

We recruited 52 participants (25 intervention; 27 control). At 6 months, 88 % (22/25) of participants randomized to the intervention arm and 59 % (16/27) of participants randomized to the control arm remained in the study. The intervention group had an average of 11 (95 % CI: [5, 18]) more website logins than the control group. Intervention group participants completed a mean of 6.2 coaching calls with high fidelity. The estimates of the effect of the intervention on mental health outcomes at 6-months were imprecise but point estimates and confidence intervals were consistent with a moderate beneficial effect of the intervention on both symptoms of depression and anxiety (fully adjusted effects sizes: 0.51 (95 % CI: [-0.14, 1.17]) and 0.56 (95 % CI: [-0.09, 1.22]), respectively).

CONCLUSIONS

WBIs with coaching are feasible, acceptable, and potentially effective treatment options for women with mild to moderate postpartum depression and/or anxiety. The addition of coaching calls markedly increased engagement with the WBI, but a larger RCT is needed to determine the effectiveness of such an intervention.

The information behaviours of disadvantaged young first-time mothers

Purpose

The purpose of this study is to explore the information behaviours of socioeconomically disadvantaged young first-time mothers, an understudied and at-risk group (health and well-being).

Design/methodology/approach

Questionnaire and semi-structured interviews with 39 young mothers (aged up to 25 years of age) from UK areas of multiple deprivations.

Findings

Our participants' preferred sources of information are interpersonal sources with which they have formed close supportive relationships. Support groups are important sources of interpersonal connection, but young mothers are reluctant to attend groups involving older mothers. With the exception of support group staff and health visitors, institutional and professional information sources are used very little. Societal stigma is a significant issue influencing behaviours, but issues of institutional bureaucracy, information overload, conflicting information and practical access are also reported. A further key factor influencing behaviour is self-identity.

Research limitations/implications

Findings should not be considered representative of young mothers as a whole as not all young mothers are disadvantaged. As our participants identified as ethnically white, findings also cannot speak to the additional barriers experienced by women of colour. Further studies with further population groups are recommended. More broadly, further studies exploring the influence of self-identity on people's information behaviours are also recommended.

Practical implications

Findings provide practical direction for health and welfare services, and public libraries, to better support young mothers.

Originality/value

Findings contribute to conceptual and practical understanding of information poverty in the socio-ecological context. Findings also evidence the role of self-identity in shaping people's information behaviours.

Nutrition Practitioner Perceptions of Nutrition Education with Pregnant Clients

OBJECTIVE

Nutrition education during pregnancy is associated with improved maternal and fetal outcomes. This study explored nutrition practitioner perceptions of providing nutrition education to this population and examined gaps in current practices.

METHODS

North Carolina nutrition practitioners (n = 73) working with pregnant women were asked to complete a survey about their provision of nutrition services to pregnant clients. Data were analyzed for descriptive statistics.

RESULTS

Cost (91%) and lack of time to cook (83%) were perceived as the largest barriers for clients to making dietary changes. Topics most requested by clients paralleled those practitioners identified as needs: weight gain (69%), lactation (63%), and general nutrition information (57%). Pamphlets (97%), posters (66%), telehealth (42%), and texting (38%) were accepted education methods.

CONCLUSIONS AND IMPLICATIONS

Evidence-based education on weight, lactation, and general nutrition, using time and cost-efficient approaches, and embracing technology were desired by pregnant clients when receiving nutrition education from nutrition and other health care practitioners and may result in improved maternal and fetal outcomes.

Overview of a new eHealth intervention to promote healthy eating and exercise in pregnancy: Initial user responses and acceptability

PURPOSE

The purpose of this project was to develop and evaluate an eHealth intervention to promote healthy lifestyle for pregnant women. The setting was a low socio-economic and multi-ethnic area in Melbourne, Australia.

METHODS

This paper briefly describes the development of the eHealth intervention, which was aimed at a low level of literacy, and the evaluation of the intervention by pregnant women. A basic descriptive survey was undertaken to evaluate user friendliness, usefulness and acceptability of the intervention.

RESULTS

The intervention was developed by a team of experts and forty pregnant women participated in the evaluation. Results indicated that participants found the intervention informative, useful and easy to navigate. They also identified some minor areas for improvement which will be addressed prior to proceeding to a formal controlled evaluation.

CONCLUSION

Results from this evaluation are encouraging and suggest that women found the intervention convenient, trustworthy and engaging. Most enjoyed navigating the website information. As such, it is likely to prove a useful support for delivering dietary and exercise information to pregnant women in the local low socio-economic area. Further formal evaluation will test the efficacy of the website in improving diet and exercise outcomes during pregnancy.

UK Internet antenatal dietary advice: a content accuracy and readability analysis

The aim of the study was to assess the accuracy and readability of Internet prenatal nutrition advice. Between August and December 2018, 130 Internet pages returned from Google searches on foods to avoid, foods to eat and supplements use were compared with UK government advice for pregnant women. Readability was assessed using the Flesch Readability Ease (FRE) tool. Descriptive and non-parametric tests were used. Spearman's correlation explored associations between accuracy and readability. Kruskal-Wallis tests with Bonferroni correction were used for multiple pairwise tests and Mann-Whitney U tests for two-sample differences in medians. A total of 130 Internet pages were examined: 48 % from publishers, 27 % from other commercial organisations, 22 % from charities and 3 % from governments. Eighty-three (64 %) pages contained inaccurate and accurate advice, twenty-three (18 %) were accurate and complete, twenty-one (16 %) were inaccurate, and three (2 %) lacked any relevant advice. The median percentage accuracy of all advice was 83 (lower quartile, upper quartile: 48, 100). Median FRE was 55 (46, 61) 'fairly difficult'. Eighty-seven pages (67 %) scored below the recommended FRE for public Internet pages. There was a weak positive correlation between accuracy and readability of Internet pages (rho = 0·241, P = 0·006). Accuracy of Internet pages did not differ by dietary theme. Pages on supplements were the most difficult to read. Internet pages from publishers and other commercial organisations were significantly less accurate than those from not-for-profit organisations (median percentage difference -8 (-29, 0·00), P = 0·019). Much pregnancy-related dietary advice online is inaccurate and difficult to read. Advice should be developed in consultation with qualified nutritionists and dietitians.

The complex information needs of disadvantaged young first-time mothers: insights into multiplicity of needs

Purpose

The purpose of this paper is to holistically explore the information needs of socioeconomically disadvantaged young first-time mothers and associated issues of complexity.

Design/methodology/approach

This paper used survey and semi-structured field interviews with 39 young mothers (aged 15–23) from UK areas of multiple deprivations.

Findings

Participants reported multiple and complex needs spanning interrelated topics of parenting, poverty and personal development. In the majority of instances, participants were either unsure of their ability to meet their needs or needed help with needs, and several described situations of considerable anxiety and stress. Multiplicity is identified and conceptualised as an important factor contributing to complexity, including three component elements: simultaneous occurrence of needs (concurrency), relationships between needs (interconnectivity) and evolving needs (fluidity). In various combinations, these elements influenced a mother's actions and/or ability to selectively attend to needs, with multiple needs often competing for attention, and compounding issues of cognitive load and affect.

Research limitations/implications

This study draws attention to multiplicity of needs as an understudied topic within human information behaviour and calls for further research into how people recognise and attend to complex needs and influencing factors.

Practical implications

This study raises important questions regarding how we approach complexity of information needs in our design and delivery of information systems and services.

Originality/value

Evidences disadvantaged young mothers to have more extensive and complex information needs than previously understood, and identifies and conceptualised multiplicity as an important factor contributing to the complexity of information needs during major life transitions such as motherhood.

Continuing Education Module-Information Needs and Information-Seeking Processes of Low-Income Pregnant Women in Relation to Digital Maternity Education Resources

Pregnant women need high-quality, timely information for self-management. The extent to which digital education resources meet their needs is unclear. This study elucidated how low-income pregnant women characterize their digital information needs and seeking processes and identified barriers/facilitators to meeting them. Focus groups bookending field-testing of a digital maternity education resource elicited barriers to and facilitators of Internet access, Internet use patterns, preferred methods to access information, and explored acceptability and desired features of online resources. Content analysis was used to analyze transcripts and six thematic categories were identified. Digital maternity education resources should be flexible, easily shared with loved ones, and responsive to users' experiences. Although helpful, digital resources are insufficient to meet pregnant women's need for social support.

Consumer health-related needs of pregnant women and their caregivers

Objectives

To build effective applications, technology designers must understand consumer health needs. Pregnancy is a common health condition, and expectant families have unanswered questions. This study examined consumer health-related needs in pregnant women and caregivers and determined the types of needs that were not met.

Materials and Methods

We enrolled pregnant women <36 weeks’ gestational age and caregivers from advanced maternal–fetal and group prenatal care settings. Participant characteristics were collected through surveys, and health-related needs were elicited in semi-structured interviews. Researchers categorized needs by semantic type and whether they were met (ie, met, partially met, or unmet). Inter-rater reliability was measured by Cohen’s kappa.

Results

Seventy-one pregnant women and 29 caregivers participated and reported 1054 needs, 28% unmet, and 49% partially met. Need types were 66.2% informational, 15.9% logistical, 8.9% social, 8.6% medical, and 0.3% other. Inter-rater reliability was near perfect (κ=0.95, P < 0.001).

Discussion

Common topics of unmet needs were prognosis, life management, and need for emotional support. For pregnant women, these unmet needs focused around being healthy, childbirth, infant care, and being a good mother; caregivers’ needs involved caring for the mother, the natural course of pregnancy, and life after pregnancy.

Conclusion

Pregnant women and caregivers have a rich set of health-related needs with many not fully met. Caregivers’ needs differed from those of pregnant women and may not be adequately addressed by resources designed for mothers. Many unmet needs involved stress and life management. Knowledge about consumer health needs can inform the design of better technologies for pregnancy.

Pregnant women's knowledge and awareness of nutrition

The purpose of this study was to investigate effectiveness of an educational intervention on pregnant women's nutritional knowledge. Despite national guidelines, women face personal and healthcare barriers to adequate nutrition education. This quasi-experimental study involved a convenience sample of pregnant women (n=27). The Nutrition Knowledge Questionnaire (NKQ) was utilized for pre and post-tests. Additionally, participants were asked open-ended questions. Data analysis was performed using paired t-tests, linear regression, and qualitative thematic analysis. The mean pre-test and post-test scores on the NKQ were 30.0 and 38.96 respectively, representing a statistically significant increase (p≤0.00). Six qualitative themes emerged including nutrition as "important" and "a real eye opener." This study validates the use of an educational intervention based on MyPlate guidelines to increase pregnant women's knowledge of nutrition.

HealthyDads.ca: What Do Men Want in a Website Designed to Promote Emotional Wellness and Healthy Behaviors During the Transition to Parenthood?

BACKGROUND

Up to 18% of men experience depression and/or anxiety during the transition to parenthood. Interventions designed specifically to promote the mental health of men during the transition to parenthood are scarce. Internet-delivered interventions may be acceptable and far-reaching in enhancing mental health, parenting knowledge, and healthy behaviors in expectant or new fathers.

OBJECTIVE

To guide the development of Healthydads.ca, a website designed to enhance mental health and healthy behaviors in expectant fathers, a needs assessment was conducted to identify fathers' perspectives of barriers to seeking help for emotional wellness, informational needs, and factors affecting the decision to visit such a website.

METHODS

One hundred and seventy-four men whose partners were expecting, or had recently given birth, in 3 Canadian provinces (Quebec, Ontario, and Alberta) completed a Web-based survey inquiring about information needs related to psychosocial aspects of the transition to parenthood, lifestyle behaviors, parenting, and factors associated with the decision to visit a father-focused website.

RESULTS

Most men (155/174, 89.1%) reported accessing the Internet to obtain information on pregnancy and spent an average of 6.2 hours online per month. Seeking information about parenting on the Internet was reported by 67.2% (117/174) of men, with a mean of 4.4 hours per month of online searching. Top barriers to seeking help to improve emotional wellness during the perinatal period were: no time to seek help/assistance (130/174, 74.7%), lack of resources available in the health care system (126/174, 72.4%), financial costs associated with services (118/174, 67.8%), and feeling that one should be able to do it alone (113/174, 64.9%). Information needs that were rated highly included: parenting/infant care (52.9-81.6%), supporting (121/174, 69.5%) and improving (124/174, 71.3%) relationship with their partner, work-family balance (120/174, 69.0%), improving sleep (100/174, 57.5%), and managing stress (98/174, 56.3%). Perceiving the website as personally relevant (151/174, 86.8%), credible (141/174, 81.0%), effective (140/145, 80.5%), and having an easy navigation structure (141/174, 81.0%) were identified as important factors related to a first website visit. Providing useful (134/174, 77.0%) and easy to understand (158/174, 90.8%) information, which was also free of charge (156/174, 89.7%), were considered important for deciding to prolong a website visit. Providing the possibility to post questions to a health professional (133/174, 76.4%), adding new content regularly (119/174, 68.4%), and personal motivation (111/174, 63.8%) were factors identified that would encourage a revisit.

CONCLUSIONS

Our findings demonstrate that there is substantial interest among expectant and new fathers for using Internet-delivered strategies to prepare for the transition to parenthood and support their mental health. Specific user and website features were identified to optimize the use of father-focused websites.

A social network analysis of supportive interactions on prenatal sites

Objective

The purpose of this exploratory study was to validate and extend previous research on social support by identifying which dimensions of social support are most commonly exchanged on health-related social networking sites and how social network structure varies with each support dimension exchanged.

Methods

This research applies a multiple case study approach by examining two social networking sites that focus on pregnancy and prenatal health. For one month, support seeking and providing messages were content analyzed and a social network analysis examined the connections between members.

Results

The sample size consisted of 525 support-seeking messages and 1965 support-providing messages. Findings indicate that participants requested informational and emotional support more than esteem and network support, with no requests for tangible support. Findings also suggest participants substituted emotional support for informational support when they were unable to provide the information sought. The social network analysis showed that network structure varied across support dimensions, with the informational and emotional support networks having the largest number of members and greatest density and reciprocity.

Conclusions

This study suggests that online support networks are fairly effective in meeting participants’ needs. The support dimension sought was generally provided and when it was not another dimension of support may have been substituted; thus, participants may have benefitted in unintended ways. The data also suggest there may be an optimal network size to support member engagement, whereby too large of a network may facilitate diffusion of responsibility and too small a network may not facilitate enough momentum to support a well-connected community.