Pilot evaluation of HEAL – A natural experiment to promote obesity prevention behaviors among low-income pregnant women

Abstract

Instituting interventions during the prenatal period is optimal for early obesity prevention in the child. Healthy Eating Active Living (HEAL) is a six-week, multi-component program to promote breastfeeding, healthy dietary habits, cooking skills and physical activity among Medicaid-eligible pregnant-women in Texas. HEAL is integrated into the healthcare system and offered as a standard-of-care for eligible patients. Methods: Preliminary evaluation of this natural experiment conducted from March 2015 through October 2016 informs the initial feasibility, acceptability and effects of the program on participant diet, home nutrition environment, physical activity, and breastfeeding self-efficacy and intentions measured using self-report surveys. Analysis of covariance (ANCOVA) was conducted to evaluate pre- and post-intervention changes, controlling for participants' ethnicity, age, and income level. Interaction effects of session attendance on the outcomes were further assessed. Results: Of the 329 women who enrolled in HEAL, 210 women completed the pre-post assessment (64% retention rate). Pre-to-post intervention, there were significant increases in availability and intake of fruits and vegetables, self-efficacy towards consuming more fruits and vegetables, and cooking frequency and skills (p < 0.05), and decreased frequency of eating heat and serve foods (p < 0.05). Significant improvements in physical activity, duration of breastfeeding, perceived benefits and intentions to breastfeed were also observed (p < 0.05). Higher attendance of HEAL sessions was associated with better outcomes. Process evaluation demonstrated 95% fidelity of program implementation. Conclusion: HEAL operationalizes clinic-community linkages and shows promise in improving behaviors during pregnancy. Future research warrants the use of a stringent study design with a control group to determine program efficacy.

Culinary medicine and culinary nutrition education for individuals with the capacity to influence health related behaviour change: A scoping review

“…20,31,37,38,41,43,48,52 When CM/CN interventions were provided to the general community, most were delivered by nutrition and/or public health students 26,28,[33][34][35]55 and/or dietitians. 28,40,[49][50][51] Although medical graduates could benefit from the ability to discuss nutrition with their patients 7 and lead coordination of nutrition care with other professionals, particularly dietitians, 56 they report that nutrition education and/or training if provided, is commonly insufficient. 7 The need for better nutrition education for medical practitioners 7,10,12 and other health professionals has been reported.…”

A Qualitative Study of Motivators, Strategies, Barriers, and Learning Needs Related to Healthy Cooking during Pregnancy

“…A systematic review of culinary nutrition education interventions during preconception, pregnancy, and postpartum, found that the majority (80%) of interventions were “conducted during the postpartum period and targeted nutrition issues in infants and young children”; only 20% of interventions were conducted during pregnancy and none pre-conception [ 14 ]. Cooking programs conducted during pregnancy tend to commence during the second trimester [ 43 , 44 , 45 , 46 , 47 , 48 ]. Participants in our study thought it would be important for an intervention to start earlier in pregnancy; they expressed frustration with lack of early prenatal care and thought that a cooking program could help address first-trimester symptoms such as food aversions, nausea, and fatigue.…”

“…The modality and content of existing cooking interventions targeting pregnancy are quite variable, with the majority of cooking programs delivered as one component of a larger lifestyle intervention [ 43 , 44 , 45 , 46 , 47 , 48 ]. Most existing programs have used primarily in-person, hands-on learning in a group setting [ 43 , 44 , 47 , 48 ], some used demonstrations only [ 45 ] (no hands-on component) or one-on-one home visits [ 46 ].…”

“…The modality and content of existing cooking interventions targeting pregnancy are quite variable, with the majority of cooking programs delivered as one component of a larger lifestyle intervention [ 43 , 44 , 45 , 46 , 47 , 48 ]. Most existing programs have used primarily in-person, hands-on learning in a group setting [ 43 , 44 , 47 , 48 ], some used demonstrations only [ 45 ] (no hands-on component) or one-on-one home visits [ 46 ]. Though participants in our study tended to prefer hands-on, in-person learning, they also suggested a “hybrid” program that incorporates both hands-on and online learning (including videos, recipes, and/or an online discussion platform) for increased convenience and accessibility.…”

“…Existing cooking interventions during pregnancy incorporate a range of content, though in-depth descriptions of content are often absent from the literature, which makes it challenging to determine to what extent the content preferences and learning needs expressed by participants in the present study are being met by existing programs [ 14 ]. Existing programs most frequently include nutrition guidelines, food safety information, and recipes, and sometimes content related to grocery shopping and infant feeding [ 43 , 44 , 45 , 46 , 47 , 48 ]. While participants in this study felt that nutrition and food safety were important, they also warned that these topics could be more overwhelming than helpful.…”