HealthyMoms - promoting healthier lifestyle and weight gain during pregnancy with special emphasis on migrant women

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Fältnamn	Indikatorer	Metadata
000		08488nam a2200565 4500
001		oai:DiVA.org:liu-207329
003		SwePub
008		240904s2024 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
020		a 9789180756884q print
020		a 9789180756891q electronic
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-2073292 URI
040		a (SwePub)liu
041		a engb eng
042		9 SwePub
072	7	a vet2 swepub-contenttype
072	7	a dok2 swepub-publicationtype
100	1	a Söderström, Emmie,d 1990-u Linköpings universitet,Avdelningen för samhälle och hälsa,Medicinska fakulteten4 aut0 (Swepub:liu)emmso15
245	1 0	a HealthyMoms - promoting healthier lifestyle and weight gain during pregnancy with special emphasis on migrant women
264	1	a Linköping :b Linköping University Electronic Press,c 2024
300		a 118 s.
338		a electronic2 rdacarrier
490	0	a Linköping University Medical Dissertations,x 0345-0082 ;v 1923
500		a Funding: The studies in this thesis were primarily supported by the Swedish Research Council (VR) and the Swedish Research Council for Health,Working Life and Welfare (Forte). The studies also received additional funding from several funding agencies (for details see the individual Papers I-IV).
520		a 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.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Hälsovetenskap0 (SwePub)3032 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Health Sciences0 (SwePub)3032 hsv//eng
653		a Pregnancy
653		a Gestational weight gain
653		a mHealth
653		a App
653		a Diet
653		a Physical activity
653		a Validation
653		a Dietary assessments
653		a Doubly labelled water
653		a 24 h dietary recalls
653		a Migrant
653		a Healthcare
653		a Maternity care
653		a Qualitative re-search methods
700	1	a Löf, Marie,c Professor,d 1971-u Linköpings universitet,Avdelningen för samhälle och hälsa,Medicinska fakulteten4 ths0 (Swepub:liu)marlo59
700	1	a Müssener, Ulrika,c Associate Professor,d 1974-u Linköpings universitet,Avdelningen för samhälle och hälsa,Medicinska fakulteten4 ths0 (Swepub:liu)ulrkl01
700	1	a Henriksson, Pontus,c Associate Professor,d 1982-u Linköpings universitet,Avdelningen för samhälle och hälsa,Medicinska fakulteten4 ths0 (Swepub:liu)ponhe11
700	1	a Blomberg, Marie,c Professor,d 1963-u Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Region Östergötland, Kvinnokliniken US4 ths0 (Swepub:liu)marce21
700	1	a Redman, Leanne,c Professoru Pennington Biomedical Research Center, Baton Rouge, USA4 opn
710	2	a Linköpings universitetb Avdelningen för samhälle och hälsa4 org
856	4	u https://doi.org/10.3384/9789180756891y Fulltext
856	4	u https://liu.diva-portal.org/smash/get/diva2:1894960/FULLTEXT01.pdfx primaryx Raw objecty fulltext
856	4	u https://liu.diva-portal.org/smash/get/diva2:1894960/PREVIEW01.pngx Previewy preview image
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-207329

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