Understanding Strategies to Manage Gestational Weight Gain in Overweight/obese Prenatal Women: Integrating Theory, Technology, and Healthcare Provider Beliefs
Open Access
- Author:
- Rauff, Erica
- Graduate Program:
- Kinesiology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- October 10, 2013
- Committee Members:
- Danielle Symons Downs, Dissertation Advisor/Co-Advisor
Danielle Symons Downs, Committee Chair/Co-Chair
Richard Scott Legro, Committee Member
Jennifer Savage, Committee Member
Melissa Jean Bopp, Committee Member - Keywords:
- pregnancy
weight gain
technology
theory
provider beliefs - Abstract:
- The overall purpose of this dissertation is to understand strategies for how to better manage gestational weight gain (GWG) in overweight and obese pregnant women (OW/OBPW). To accomplish this aim, three studies were conducted to examine the roles of theoretical determinants of GWG, technology for delivering interventions to manage weight, and OBGYN healthcare providers’ preferences regarding the clinical management of GWG and the use of technology to promote healthy eating and physical activity (PA) behaviors for managing GWG. The first study aimed to examine how the motivational determinants of PA within the framework of the Theory of Planned Behavior predicted PA intention and PA behavior across pregnancy trimesters and if the motivational determinants of PA and PA behavior predict GWG. Results from the first study suggest that the primary predictors of intention were perceived behavioral control (PBC; 1st to 2nd trimester) and attitude (ATT; 2nd to 3rd trimester). The primary predictor of PA behaviors was intention (INT; from both the 1st to 2nd and 2nd to 3rd trimesters). Weight status (normal weight vs. OW/OB) also moderated the relationship between INT, SN, and PA behavior with GWG such that subjective norm (SN) was a stronger predictor of GWG for OW/OBPW whereas INT and PA behavior were stronger predictors of GWG in normal weight women. Findings from study one provide evidence for targeting different constructs in OW/OBPW than in normal weight women, particularly focusing on OW/OBPW’s SN as well as INT since INT was the most salient predictor of PA behavior The second study aimed to descriptively review e-health interventions for weight loss, weight maintenance, or prevention of weight gain in non-prenatal adults to identify unique intervention characteristics used in OW/OB adults and to determine if the effectiveness of e-health interventions differed by weight status groups. Study two findings illustrated that unique differences were observed such that interventions in OW/OB adults were more intensive and included greater face-to-face counseling, more regular contact with participants, more feedback to participants about their behaviors, and were longer in duration than those studies conducted in normal weight adults. A small number of studies in both populations were theoretically-based and few studies examined intervention fidelity or user acceptability of the technology, thus, highlighting the need to include these components in future behavioral interventions for weight loss in OW/OB adults, and particularly when considering the development of prenatal interventions for managing GWG. Finally, study three aimed to examine OBGYN providers’ beliefs and preferences for incorporating e-health technology into prenatal care, barriers in using e-health technology in prenatal care, and perceptions of their patients’ barriers in using e-health technology to monitor diet and PA behaviors to manage GWG. Study three results suggests that providers appear to be recommending technology (i.e., websites) for their patients even if they aren’t currently using any in their clinical care or counseling with their patients. Providers’ responses are important for understanding what type of tool may be feasible for providers to use (e.g., smartphone applications), how often and with what patients (e.g., high risk women such as OW/OBPW) they would be likely to use the technology with. Collectively, these studies suggest that future prenatal interventions for managing GWG in OW/OBPW should consider using e-health approaches endorsed by providers that are theoretically-based and include constructs from the Theory of Planned Behavior (e.g., SN, INT, PBC) as well as measures of intervention fidelity to ensure that interventions are delivered effectively.