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- Söderström, Emmie, 1990-
(författare)
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HealthyMoms - promoting healthier lifestyle and weight gain during pregnancy with special emphasis on migrant women
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Gestational weight gain (GWG), affects almost 50% of pregnant women and effective and scalable interventions are needed and should be inclusive for all irrespectively of origin. The overall aim of this thesis was to evaluate the HealthyMoms app targeting GWG as well as dietary and physical activity behaviors and how the app may be adapted to also reach women of migrant backgrounds. The first part evaluated the effectiveness of the HealthyMoms trial and the dietary assessment method used in it (Paper I-II). The second part aimed to explore how the HealthyMoms app could be adapted to reach Arabic- and Somali-speaking women (Paper III-IV). Methods: Paper I was a randomized controlled trial in healthy pregnant women (n=305). After baseline assessment (week 14), women were randomized to the intervention (n=152) or control group (n=153). The intervention group received standard care and the HealthyMoms app. The primary outcome was GWG between baseline and follow-up measurement (week 37). Secondary outcomes included body fatness (air displacement plethysmography), dietary habits (SHEI score), moderate-to-vigorous physical activity (accelerometry), glycemia and insulin resistance. Paper II: Nested validation study of RiksmatenFlex (dietary assessment method in HealthyMoms) in a subsample of the trial. Three days of dietary data (energy, foods groups, macronutrients and SHEI score) from RiksmatenFlex was compared to 24 h telephone dietary recalls (n=52). Total energy expenditure (TEE) was measured with the doubly labelled water method (n=24). Paper III: A qualitative exploration of healthcare professionals’ views on supporting healthy lifestyle behaviors in pregnant migrant women was performed through individual interviews over phone or in person with healthcare professionals working in maternity healthcare (n=14). An inductive thematic analysis was performed. Paper IV: Individual interviews with Arabic (n=10) and Somali women (n=9) exploring what support is needed for healthy lifestyle behaviors and how the HealthyMoms app could be adapted. Data was analyzed using content analysis (inductive latent approach). Results: Paper I: No statistically significant effect on GWG was observed, although data indicated that the effect of the HealthyMoms app differed according to pre-pregnancy BMI, where women with overweight and obesity in the intervention group had lower GWG compared to the control group in the imputed (–1.33 kg; 95% CI –2.92 to 0.26; P=.10) and completers-only analyses (–1.67 kg; 95% CI –3.26 to –0.09; P=.031). Participants in the intervention group further had higher SHEI score at follow-up compared to the control group (0.27; 95% CI 0.05-0.50; P=.017). No other effects for secondary outcomes were found. Paper II: Average energy intake from RiksmatenFlex (10015 [SD 2004] kJ) was similar to TEE (10252 [SD 1197] kJ) (P=.596). Mean differences between average intakes of unhealthy and healthy foods and average SHEI score between RiksmatenFlex and 24 h telephone dietary recalls were small, although Bland and Altman analyses showed wide limits of agreement for all variables. Moreover, correlations between dietary variables assessed with the two dietary methods were high (r=0.751-0.931; P<.001). Paper III: Healthcare professionals discussed challenges in their health promotion work including cultural and educational aspects as well as the need of increased awareness among pregnant migrant women and persons in the social context. Healthcare professionals further highlighted a lack of resources in the clinical practice and a need for increased cultural awareness in themselves to support healthy lifestyle behaviors. Providing the HealthyMoms app in Arabic and Somali with culturally adjusted information could be a helpful tool for women and for healthcare professionals in maternity healthcare. Paper IV: Arabic- and Somali-speaking women expressed a need of more knowledge about pregnancy and healthy lifestyle behaviors. The social context, and especially partners could support lifestyle behaviors. The social context could further be a source of misinformation which might negatively affect women’s diet or physical activity. Women had high trust in maternity healthcare but wanted more information related to lifestyle behaviors. A translated HealthyMoms app was seen as a helpful support for lifestyle behaviors, and it was reported that translation alone could be sufficient, however, audio- and video content was requested as well as inclusion of partners in the app. Conclusions: This thesis shows that the HealthyMoms app significantly improved dietary habits among pregnant women and has potential to reduce GWG in women with overweight and obesity. The dietary assessment method (RiksmatenFlex) showed acceptable agreement for average energy, macronutrients, key food groups and adherence to dietary guidelines, which strengthens the credibility of the obtained trial results and supports further use of the method. Finally, this thesis demonstrates the potential of the HealthyMoms app also for Arabic- and Somali-speaking women, i.e., two of the largest migrant groups in Sweden. It was requested that the app should include audio and video content, however, the need of other cultural adaptations needs further investigation.
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