Gestational weight gain, physical activity, and nutrition counselling practices of prenatal health care providers: What influences practice?

  • Author / Creator
    Morris, Jillian H
  • Appropriate gestational weight gain is important for maternal and child health. Data from a recent Alberta cohort showed 49% of pregnant women gained weight in excess of Health Canada guidelines. Regional studies have shown low rates of gestational weight gain counselling by health care providers, including general practitioners, obstetricians, midwives, nurse practitioners and registered nurses. Research is needed to determine how to support health care providers to enhance gestational weight gain counselling practices. The purpose of this study was to understand current gestational weight gain counselling practices, and the influences on health care providers’ practices. This mixed method study included semi-structured interviews and an online survey. Interviews were conducted by telephone with prenatal health care providers from Alberta and British Columbia, transcribed verbatim and analyzed using qualitative content analysis. The survey questionnaire was distributed nationally to prenatal health care providers. Responses were compared by health care provider discipline using one-way analysis of variance (ANOVA), and multiple linear regression examined influences on practices. Data were collected concurrently, analyzed separately, and integrated. Interview participants (n=23) had a range of practices for gestational weight gain counselling. Typically, weight gain information was provided early in pregnancy, but not discussed again unless there was a concern. Among survey respondents (n=508) few routinely provided women with individualized weight gain advice (21%), rate of weight gain (16%), or discussed the risks of inappropriate weight gain to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (p<0.001). Midwives interviewed noted a focus on overall wellness instead of weight, and had longer appointments for in-depth counselling. Regression results found that the priority level that health care providers place on gestational weight gain had the largest influence on providing weight gain advice and discussing the risks (β=0.71, p<0.001) and discussing physical activity and food requirements (β=0.341, p<0.001). Interview data linked the priority level of gestational weight gain to length of appointments, compensation methods for health care providers, knowledge of health care providers, and the midwifery versus medical model of care. In conclusion, interventions for health care providers to enhance gestational weight gain counselling practices should consider the range of factors that influence the priority level health care providers place on gestational weight gain counselling.

  • Subjects / Keywords
  • Graduation date
    Fall 2016
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.