Dutch Midwives’ Behavior and Determinants in Promoting Healthy Gestational Weight Gain, Phase 1: A Qualitative Approach

Abstract

BACKGROUND: A significant contributor to the global threat of obesity is excessive gestational weight gain (GWG). The aim of this article is to explore Dutch primary care midwives’ behaviors in promoting healthy GWG.METHODS: We used the attitude–social influence–self-efficacy (ASE) model to guide interviews with a purposive sample of 6 midwives working in primary care.RESULTS: Midwives reported activities in 3 areas related to GWG: GWG monitoring (weighing and discussing GWG), diet education, and to a lesser degree physical activity education. The determinants from the ASE model were confirmed and other relevant determinants, including midwives’ perception of their role in health promotion, were added.PRACTICE IMPLICATIONS: The identified determinants can be used for quantitative research. Quantitative research is necessary to identify the magnitude of the determinants associated with midwives’ behavior in promoting healthy GWG.

In search of balance

“…A decline in PA was associated with GWG above the guidelines. Our qualitative study of six community midwives showed that midwives did monitor GWG (weighing and discussing GWG), offered education about diet, and, to a lesser degree, offered education about healthy PA. 204 Behavioural determinants, originating from the ASE model, 258 were confirmed and other relevant themes, including midwives' perception on their role in health promotion were added to our hypothetical model explaining midwives' behaviour in respect to promoting healthy GWG.…”

“…183 Antenatal care providers, including midwives, confirm they give low priority to motivating pregnant women to have healthy levels of PA and they often give women advice to slow down. 185,[202][203][204][205] Since prenatal PA is associated with better outcomes, 22, 159, 173-176 future interventions should aim to increase knowledge in both midwives and pregnant women and should emphasize the importance of healthy PA (e.g., moderate active activities including walking, biking, swimming) during pregnancy. Midwives may also advise women to slow down because of their concern about the growing psychological complaints women experience.…”

“…We used qualitative studies to adapt the general ASE-model to build our hypothesized model. 204,227 Attitude, social influence, self-efficacy and barriers are related to a specific behaviour (grey boxes in Figure 6.1). The attitudes related to Diet-Education (such as "I believe Diet-Education is important"), e.g., can differ from attitudes toward Monitoring GWG ("I believe Monitoring GWG is important").…”

“…143 The Dutch midwifery system is described elsewhere. 204 Qualitative studies of midwives have examined their educational needs and explored determinants related to their behaviour in promoting healthy GWG. 204,227 Midwives revealed their need for training and education by acknowledging a lack of relevant skills and knowledge.…”

“…204 Qualitative studies of midwives have examined their educational needs and explored determinants related to their behaviour in promoting healthy GWG. 204,227 Midwives revealed their need for training and education by acknowledging a lack of relevant skills and knowledge. Moreover, midwives had varying attitudes toward promoting healthy GWG, and their engagement in health promotion in general seemed to influence their daily practice in promoting healthy GWG.…”