Healthy Eating Among Low-Income Pregnant Women Using a

Healthy Eating Among Low-Income Pregnant Women: Using a Positive Deviance Approach to Customize Nutrition Education Materials Nation’s First Collaborative School of Public Health Jaimee Ryan, BS, Rickie G. Kashdan, MPH, M. Jane Lewis, Dr. PH, Donna Hayek, RD INTRODUCTION Background Although barriers to good nutrition among low-income pregnant women exist, some women are still successful in consuming a healthy diet. Using a positive deviance approach, this project aimed to identify factors that enabled some pregnant women within a lowincome community to maintain a healthy diet during pregnancy. Personal, environmental, and behavioral factors that enable “healthy eaters” to eat healthfully were identified. This information will be used to customize nutrition education materials for the prenatal clinic that serves the same population from which the “healthy eaters” were derived. RESEARCH APPROACH Positive Deviance A qualitative approach to research characterized by the assumption that solutions to specific problems are present within the community. Steps in a positive deviance approach: • finding positive deviants, • identifying factors that enable positive deviants to be successful, • designing interventions enabling others to implement desired behaviors, • assessing effectiveness of the intervention, and Research Question What are the personal, environmental, and behavioral factors that influence healthy eating among low-income pregnant women? METHODS Results are based on qualitative analysis of 30 individual interviews with low-income, pregnant “healthy eaters. ” Participants (15 Spanish -speaking and 15 English-speaking) were recruited from a community clinic in Neptune, NJ. A Spanish interpreting service was utilized for interviews with Spanish speakers. Interview recordings were reviewed and coded using SPSS software. What special things do you do to be sure that you eat healthy meals during your pregnancy? • “I have a book and an app on my phone and it tells a lot of healthy foods, so I always write them down and try…to get those foods…” • “If I’m going to be out and about, I always pack lots of snacks…fruit, granola bars, cereals…stuff like that” What makes it hard to eat healthy meals during pregnancy? • disseminating the intervention. Positive Deviants: Individuals who defy community norms and are successful at overcoming the identified problem. In this case, “healthy eaters” are the positive deviants. RESULTS: Environmental, Personal, Behavioral Factors • “Sometimes it takes too much time to cook…sometimes the cost is high…it’s more expensive to buy healthy food than fast food…” • “Sometimes I get cravings for junk food…” • “Because it doesn’t taste good. ” Why do you think some mothers are successful at eating healthy foods during pregnancy? Physical Environment • “Maybe support…family encouraging you to eat healthy…not being counterproductive…” • 96. 7% have space and appliances to prepare meals Social Support Demographic Characteristics (n=30) Mean Age RESULTS: In their own words 24. 7 ± 4. 2 yrs • “I think it’s based on self-control…I also think it’s based on what’s going on during the pregnancy…you know, if the father is there, it’s a lot easier, you’re not so stressed out. ” • 100% have friends or family nearby • “I think you have to make an effort to eat well…” • 93. 3% can easily get to the store to buy food WIC Participation 83. 3% (25) • 87% are married/partnered Married/Couple 86. 7% (26) DISCUSSION Self-efficacy • 93. 1% believe they are successful at eating healthy meals Race/Ethnicity Caucasian 23. 3% (7) African American 10. 0% (3) Hispanic Other 53. 3% (16) 13. 3% (4) • 83. 3% ate healthy meals prior to becoming pregnant Skills • 93. 3% regularly cook for their families • 96. 7% regularly go food shopping Healthy eating behaviors Education 43. 3% (13) • Frequently eats at home (86. 7%), eats breakfast (83. . 3%), and snacks (70. 0%) High school graduate 23. 3% (7) • Rarely eats fast food (86. 7%), skips meals (79. 3%), or drinks soft drinks (73. 3%) Some college+ 33. 3% (10) • 67% changed eating habits once becoming pregnant Less than high school While our initial research question dealt with customizing educational materials, our findings indicate that information alone may not suffice to enable low-income pregnant women to eat healthfully. Although materials will still be customized, attention to social support, motivation, and self-efficacy is needed as well. In addition to education, services such as home visitation, WIC, or mentoring relationships would increase the social support available to those women with little to no support. Assessing women’s motivation to eat well during pregnancy could help them set appropriate, attainable goals, thus increasing self-efficacy. Caution needs to be taken when generalizing results to similar populations because the sample size was small, the data were selfreported, and responses could have been affected by the language/cultural barrier. For more information, please contact Jaimee Ryan: reedyjr@umdnj. edu