“…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study
Autoři:
Anne Christenson aff001; Eva Johansson aff003; Signy Reynisdottir aff001; Jarl Torgerson aff004; Erik Hemmingsson aff005
Působiště autorů:
Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
aff001; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
aff002; Department of Public Health Sciences (IHCAR), Karolinska Institutet, Stockholm, Sweden
aff003; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
aff004; The Swedish School of Sports and Health Sciences, Åstrand Laboratory of Work Physiology, Stockholm, Sweden
aff005
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0222543
Souhrn
Introduction
The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management.
Methods
Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19–39 y) with obesity. Thematic analysis was used to analyze the data.
Results
We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives’ approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation.
Conclusions
A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients’ background, have a non-judgmental approach and refrain from giving unsolicited advice.
Klíčová slova:
Body Mass Index – Biology and life sciences – Psychology – Social sciences – People and places – Population groupings – Professions – Medicine and health sciences – Physiology – Physiological parameters – Women's health – Maternal health – Obstetrics and gynecology – Medical personnel – Pregnancy – Body weight – Emotions – Obesity – Midwives – Weight gain
Zdroje
1. World Health Organization. (WHO). In: Obesity and overweight: Fact sheet [Internet]. 2018 [cited 19 Jun 2019]. Available: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight
2. Deputy NP, Dub B, Sharma AJ. Prevalence and Trends in Prepregnancy Normal Weight—48 States, New York City, and District of Columbia, 2011–2015. MMWR Morb Mortal Wkly Rep. 2018;66: 1402–1407. doi: 10.15585/mmwr.mm665152a3 29300720
3. Devlieger R, Benhalima K, Damm P, Van Assche A, Mathieu C, Mahmood T, et al. Maternal obesity in Europe: where do we stand and how to move forward?: A scientific paper commissioned by the European Board and College of Obstetrics and Gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol. 2016;201: 203–208. doi: 10.1016/j.ejogrb.2016.04.005 27160501
4. The national board of health and welfare. Obesity in pregnancies. In: Swedish pregnancy data base [Internet]. 2016. Available: http://www.socialstyrelsen.se/statistik/statistikdatabas/graviditeter-forlossningarochnyfodda
5. Bjermo H, Lind S, Rasmussen F. The educational gradient of obesity increases among Swedish pregnant women: a register-based study. BMC Public Health. 2015;15: 315. doi: 10.1186/s12889-015-1624-6 25886465
6. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017;356: j1. doi: 10.1136/bmj.j1 28179267
7. Yang Z, Phung H, Freebairn L, Sexton R, Raulli A, Kelly P. Contribution of maternal overweight and obesity to the occurrence of adverse pregnancy outcomes. Aust New Zeal J Obstet Gynaecol. 2018;0. doi: 10.1111/ajo.12866 30024043
8. Shub A, Huning EY-S, Campbell KJ, McCarthy EA. Pregnant women’s knowledge of weight, weight gain, complications of obesity and weight management strategies in pregnancy. BMC Res Notes. 2013;6: 278. doi: 10.1186/1756-0500-6-278 23866845
9. Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. Women’s perceived reasons for their excessive postpartum weight retention: A qualitative interview study. PLoS One. 2016;11. doi: 10.1371/journal.pone.0167731 27936110
10. Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. Obesity and Weight Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle Interventions to Inform Maternal and Child Health Policies. Front Endocrinol (Lausanne). 2018;9: 546. doi: 10.3389/fendo.2018.00546 30319539
11. Nilses C, Persson M, Lindkvist M, Petersson K, Mogren I. High weight gain during pregnancy increases the risk for emergency caesarean section—Population-based data from the Swedish Maternal Health Care Register 2011–2012. Sex Reprod Healthc. 2017;11: 47–52. doi: 10.1016/j.srhc.2016.08.004 28159128
12. Robillard P-Y, Dekker G, Boukerrou M, Le Moullec N, Hulsey TC. Relationship between pre-pregnancy maternal BMI and optimal weight gain in singleton pregnancies. Heliyon. 2018;4: e00615. doi: 10.1016/j.heliyon.2018.e00615 29872753
13. Haby K, Glantz A, Hanas R, Premberg Å. Mighty Mums—An antenatal health care intervention can reduce gestational weight gain in women with obesity. Midwifery. 2015;31: 685. doi: 10.1016/j.midw.2015.03.014 25912510
14. Lindholm ES, Norman M, Kilander CP, Altman D. Weight control program for obese pregnant women. Acta Obstet Gynecol Scand. 2010;89: 840–843. doi: 10.3109/00016340903428370 19961277
15. Knight-Agarwal CR, Williams LT, Davis D, Davey R, Shepherd R, Downing A, et al. The perspectives of obese women receiving antenatal care: A qualitative study of women’s experiences. Women and Birth. 2016;29: 189–195. doi: 10.1016/j.wombi.2015.10.008 26563638
16. Mcdonald SD, Pullenayegum E, Taylor VH, Lutsiv O, Bracken K, Good C, et al. Despite 2009 guidelines, few women report being counseled correctly about weight gain during pregnancy. Am J Obstet Gynecol. 2011;205: 333.e1–333.e6. doi: 10.1016/j.ajog.2011.05.039 21784404
17. Lindsay AC, Wallington SF, Greaney ML, Tavares Machado MM, De Andrade GP. Patient-Provider Communication and Counseling about Gestational Weight Gain and Physical Activity: A Qualitative Study of the Perceptions and Experiences of Latinas Pregnant with their First Child. Int J Environ Res Public Health. 2017;14. doi: 10.3390/ijerph14111412 29156548
18. Dencker A, Premberg A, Olander EK, McCourt C, Haby K, Dencker S, et al. Adopting a healthy lifestyle when pregnant and obese—an interview study three years after childbirth. BMC Pregnancy Childbirth. 2016;16: 201. doi: 10.1186/s12884-016-0969-x 27473076
19. Nyman VMK, Prebensen AK, Flensner GEM. Obese women’s experiences of encounters with midwives and physicians during pregnancy and childbirth. Midwifery. 2010;26: 424–429. doi: 10.1016/j.midw.2008.10.008 19100667
20. Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study. Midwifery. 2018;63. doi: 10.1016/j.midw.2018.04.020 29751291
21. Heslehurst N, Russell S, McCormack S, Sedgewick G, Bell R, Rankin J. Midwives perspectives of their training and education requirements in maternal obesity: a qualitative study. Midwifery. 2013;29: 736–744. doi: 10.1016/j.midw.2012.07.007 22951422
22. Foster CE, Hirst J. Midwives’ attitudes towards giving weight-related advice to obese pregnant women. Br J Midwifery. 2014;22: 254–262. doi: 10.12968/bjom.2014.22.4.254
23. Patton MQ. Qualitative research & evaluation methods: integrating theory and practice. 4. ed. Qualitative research and evaluation methods. Thousand Oaks, California: Thousand Oaks, California: SAGE Publications, Inc.; 2015. doi: 10.1016/j.ymeth.2015.04.005
24. Mirijello A, D’Angelo C, Iaconelli A, Capristo E, Ferrulli A, Leccesi L, et al. Social phobia and quality of life in morbidly obese patients before and after bariatric surgery. J Affect Disord. 2015;179: 95–100. doi: 10.1016/j.jad.2015.03.030 25863007
25. Guest G, Namey E, Taylor J, Eley N, McKenna K. Comparing focus groups and individual interviews: findings from a randomized study. Int J Soc Res Methodol. 2017;20: 693–708. doi: 10.1080/13645579.2017.1281601
26. Dicicco‐Bloom B, Crabtree BF. The qualitative research interview. Med Educ. 2006;40: 314–321. doi: 10.1111/j.1365-2929.2006.02418.x 16573666
27. Kaplowitz MD. Statistical Analysis of Sensitive Topics in Group and Individual Interviews. Qual Quant. 2000;34: 419–431. doi: 10.1023/A:1004844425448
28. Lambert SD, Loiselle CG. Combining individual interviews and focus groups to enhance data richness. J Adv Nurs. 2008;62: 228–237. doi: 10.1111/j.1365-2648.2007.04559.x 18394035
29. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3: 77–101. doi: 10.1191/1478088706qp063oa
30. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26: 1753–1760. doi: 10.1177/1049732315617444 26613970
31. Rosenthal M. Qualitative research methods: Why, when, and how to conduct interviews and focus groups in pharmacy research. Curr Pharm Teach Learn. 2016;8: 509–516. doi: 10.1016/j.cptl.2016.03.021
32. Schoenberg NE, Ravdal H. Using vignettes in awareness and attitudinal research. Int J Soc Res Methodol. 2000;3: 63–74. doi: 10.1080/136455700294932
33. Barter C, Renold E. “I wanna tell you a story”: Exploring the application of vignettes in qualitative research with children and young people. Int J Soc Res Methodol. 2000;3: 307–323. doi: 10.1080/13645570050178594
34. JAVA. Declaration of Helsinki World Medical Association Declaration of Helsinki. Bull world Heal Organ. 2013; S0042-96862001000400016 [pii]
35. Olander EK, Scamell M. Teaching students about maternal obesity without creating obesity stigma. Nurse Educ Today. 2016;42: 59–61. doi: 10.1016/j.nedt.2016.04.009 27237355
36. Lavender T, Smith DM. Seeing it through their eyes: A qualitative study of the pregnancy experiences of women with a body mass index of 30 or more. Heal Expect. 2016; doi: 10.1111/hex.12339 25601510
37. Jones C, Jomeen J. Women with a BMI ≥ 30 kg/m2 and their experience of maternity care: A meta ethnographic synthesis. Midwifery. 2017. doi: 10.1016/j.midw.2017.07.011 28779644
38. Fieril DP, Olsen PF, Glantz D, Premberg DA. Experiences of a lifestyle intervention in obese pregnant women—A qualitative study. Midwifery. 2017;44: 1–6. doi: 10.1016/j.midw.2016.10.011 27863294
39. DeJong W. The stigma of obesity: the consequences of naive assumptions concerning the causes of physical deviance. Journal of health & social behavior. Albany, N.Y.:; 1980. pp. 75–87.
40. Hansson LM, Rasmussen F. Attitudes towards obesity in the Swedish general population: the role of one’s own body size, weight satisfaction, and controllability beliefs about obesity. Body Image. 2014;11: 43–50. doi: 10.1016/j.bodyim.2013.10.004 24268600
41. Das UN. Obesity: Genes, brain, gut, and environment. Nutrition. 2010;26: 459–473. doi: 10.1016/j.nut.2009.09.020 20022465
42. Puhl RM, Himmelstein MS. Adolescent preferences for weight terminology used by health care providers. Pediatr Obes. 2018;13: 533–540. doi: 10.1111/ijpo.12275 29573233
43. Sogg S, Grupski A, Dixon JB. Bad words: why language counts in our work with bariatric patients. Surg Obes Relat Dis. 2018;14: 682–692. doi: 10.1016/j.soard.2018.01.013 29525262
44. Brownfoot FC, Davey M-A, Kornman L. Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial. BJOG. 2016;123: 254–261. doi: 10.1111/1471-0528.13735 26840637
45. Allen-Walker V, Mullaney L, Turner MJ, Woodside J V, Holmes VA, McCartney DM, et al. How do women feel about being weighed during pregnancy? A qualitative exploration of the opinions and experiences of postnatal women. Midwifery. 2017;49: 95–101. doi: 10.1016/j.midw.2016.12.006 28063622
46. McDowell M, Cain MA, Brumley J. Excessive Gestational Weight Gain. J Midwifery Womens Health. 2018; doi: 10.1111/jmwh.12927 30548447
47. Santos S, Voerman E, Amiano P, Barros H, Beilin LJ, Bergstrom A, et al. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American, and Australian cohorts. BJOG. 2019; doi: 10.1111/1471-0528.15661 30786138
48. Linne Y, Dye L, Barkeling B, Rossner S. Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res. 2004;12: 1166–1178. doi: 10.1038/oby.2004.146 15292482
49. Bye A, Shawe J, Bick D, Easter A, Kash-Macdonald M, Micali N. Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach. BMC Pregnancy Childbirth. 2018;18: 114. doi: 10.1186/s12884-018-1745-x 29759082
50. Vieten C, Laraia BA, Kristeller J, Adler N, Coleman-Phox K, Bush NR, et al. The mindful moms training: development of a mindfulness-based intervention to reduce stress and overeating during pregnancy.(Report). BMC Pregnancy Childbirth. 2018;18. doi: 10.1186/s12884-018-1757-6 29859038
51. Rohatgi KW, Tinius RA, Cade WT, Steele EM, Cahill AG, Parra DC. Relationships between consumption of ultra-processed foods, gestational weight gain and neonatal outcomes in a sample of US pregnant women. PeerJ. 2017;5: e4091. doi: 10.7717/peerj.4091 29230355
52. Gresham E, Collins CE, Mishra GD, Byles JE, Hure AJ. Diet quality before or during pregnancy and the relationship with pregnancy and birth outcomes: the Australian Longitudinal Study on Women’s Health. Public Health Nutr. 2016;19: 2975–2983. doi: 10.1017/S1368980016001245 27238757
53. Kapadia MZ, Park CK, Beyene J, Giglia L, Maxwell C, McDonald SD. Weight Loss Instead of Weight Gain within the Guidelines in Obese Women during Pregnancy: A Systematic Review and Meta-Analyses of Maternal and Infant Outcomes. PLoS One. 2015;10. doi: 10.1371/journal.pone.0132650 26196130
54. Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Obstet Gynecol. 2011;117: 1065–1070. doi: 10.1097/AOG.0b013e318214f1d1 21508744
55. Denison FC, Aedla NR, Keag O, Hor K, Reynolds RM, Milne A, Diamond A on behalf of the RC of O and G. Care of Women with Obesity in Pregnancy, Green-top Guideline No. 72 [Internet]. BJOG: an international journal of obstetrics and gynaecology 2018. https://doi.org/10.1111/1471-0528.15386
56. Ruifrok AE, van Poppel MNM, van Wely M, Rogozińska E, Khan KS, de Groot CJM, et al. Association between Weight Gain during Pregnancy and Pregnancy Outcomes after Dietary and Lifestyle Interventions: A Meta-analysis. 2014;31: 353–364. doi: 10.1055/s-0033-1352484 23918523
57. Miller W., Rollnick S. Motivational Interviewing. Helping People Change. 3rd ed. Rollnick S, Miller WR, Moyers TB, editors. Guilford Press; 2012.
58. Hill B, Skouteris H, Fuller-Tyszkiewicz M. Interventions designed to limit gestational weight gain: a systematic review of theory and meta-analysis of intervention components. Obes Rev. 2013;14: 435–450. doi: 10.1111/obr.12022 23534901
59. Lundahl B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C, et al. Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials. Patient Educ Couns. 2013;93: 157–168. doi: 10.1016/j.pec.2013.07.012 24001658
60. Lindhardt CL, Rubak S, Mogensen O, Hansen HP, Lamont RF, Jorgensen JS. Training in motivational interviewing in obstetrics: a quantitative analytical tool. Acta Obstet Gynecol Scand. 2014;93: 698–704. doi: 10.1111/aogs.12401 24773133
61. Lindhardt CL, Rubak S, Mogensen O, Hansen HP, Goldstein H, Lamont RF, et al. Healthcare professionals experience with motivational interviewing in their encounter with obese pregnant women. Midwifery. 2015;31: 678–684. doi: 10.1016/j.midw.2015.03.010 25931276
62. Malta MB, Carvalhaes MA de BL, Takito MY, Tonete VLP, Barros AJD, Parada CMG de L, et al. Educational intervention regarding diet and physical activity for pregnant women: changes in knowledge and practices among health professionals. BMC Pregnancy Childbirth. 2016;16: 175. doi: 10.1186/s12884-016-0957-1 27439974
63. Beckman M, Forsberg L, Lindqvist H, Diez M, Eno Persson J, Ghaderi A. The dissemination of motivational interviewing in Swedish county councils: Results of a randomized controlled trial. PLoS One. 2017;12: e0181715. doi: 10.1371/journal.pone.0181715 28750067
64. Jelsma JGM, Simmons D, Gobat N, Rollnick S, Blumska K, Jans G, et al. Is a motivational interviewing based lifestyle intervention for obese pregnant women across Europe implemented as planned? Process evaluation of the DALI study. BMC Pregnancy Childbirth. 2017;17: 293. doi: 10.1186/s12884-017-1471-9 28882133
65. Forsberg L, Forsberg LG, Lindqvist H, Helgason AR. Clinician acquisition and retention of Motivational Interviewing skills: a two-and-a-half-year exploratory study. 2012;
66. Holton S, East C, Fisher J. Weight management during pregnancy: A qualitative study of women’s and care providers’ experiences and perspectives. BMC Pregnancy Childbirth. 2017; doi: 10.1186/s12884-017-1538-7 29020931
67. Wahedi M. Should midwives consider associated psychological factors when caring for women who are obese? Br J Midwifery. 2016;24: 724–735. doi: 10.12968/bjom.2016.24.10.724
68. Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358: 483–488. doi: 10.1016/S0140-6736(01)05627-6 11513933
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