Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT04009395 |
| Other study ID # |
V1 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
October 29, 2020 |
| Est. completion date |
April 23, 2021 |
Study information
| Verified date |
December 2021 |
| Source |
Bournemouth University |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
Obesity is on the increase and black Africans in the United Kingdom (UK) make up a
significant part of this population (32%). Weight retention after pregnancy is considered as
one of the leading causes of obesity. African women living in high-income countries have been
found to experience more weight retention after pregnancy than Caucasian women.
Healthy eating guidelines have been provided in pregnancy in the UK (National Institute for
Health and Care Excellence) and midwives have been placed to provide healthy eating advice in
pregnancy, but some studies have identified that African migrants in the UK often eat and
prepare food in a different way to the traditional British approach. It has also been
observed that the recommended advice for pregnant women, for example, the Eat well plate and
start4life are focused on traditional British foods and cooking patterns and do not include
food that would be familiar to African migrants. This may impact on the meaningfulness of
such guidance to African women. Therefore, this research aims to understand what prevents
healthy eating or makes healthy eating easier for pregnant African migrant women in the UK.
This would include understanding how healthy eating is interpreted, the cultural factors that
are considered important in healthy eating, the current sources of nutrition information and
midwives view on providing healthy eating advice to this population.
Eligibility
- Pregnant African migrant women (18 and above) attending ante-natal clinics in NHS
hospital sites.
- Midwives who provide ante-natal advice to pregnant Africans Where Study sites will be
hospitals covered by the Epsom and St Helier University trust, London North West
University Healthcare National Health Service (NHS) trust and the Lewisham & Greenwich
NHS trusts.
How: The study will involve one-on-one interviewing with pregnant women and midwives using
hospital spaces provided by the hospital. Focus group discussions with midwives will be
attempted depending on logistics. The interviews are expected to last about one hour to one
and a half hours. Interview sessions will be audio-taped with the permission of the
participants. Data collection is expected to last for 6 months.
Description:
This study is concerned with exploring the perception of pregnant African migrant women
living in the United Kingdom (UK) towards healthy eating messages and midwives perception of
providing healthy eating advice to these women. The prevalence of obesity among women of
reproductive age (15-49 years) including pregnant women is increasing nationally and
internationally. Maternal obesity has adverse consequences for both mother and child
including higher risks of perinatal mortality, Caesarean sections, preterm birth, postpartum
weight retention, increased risk of macrosomia, stillbirth, congenital malformation,
childhood overweight and obesity.
Currently postpartum weight retention is a significant contributor to the general obesity
epidemic and obesity is a significant contributor to chronic disease burden worldwide and a
public health concern. Presently, the United Kingdom (UK) has the highest level of maternal
obesity in Europe with approximately 46% of women classified as either obese (20%) or
overweight (26%) at their booking appointment. Non-Hispanic black women make up a significant
proportion (32%) of this population. With migration rates increasing, and black Africans
being considered the fastest growing ethnic group in the UK (73% of the UK population
growth), the rates of obesity in the population is expected to increase. Studies have shown
pre-pregnancy weight to be a significant predictor of weight changes in pregnancy and
postpartum weight retention certain studies have found that more African women are overweight
before pregnancy and experience more weight retention after pregnancy than Caucasian women.
However, pregnancy has been indicated as a time when public health nutrition messages can be
communicated and an "opportunity for change", with women showing an inclination to modify
behaviour. Therefore, globally and in the UK, there has been an increased interest in
dietary/healthy eating interventions in pregnancy (sometimes in addition to physical
activity) to improve folic acid intake, improve fruits and vegetables intake, limit
gestational weight gain, and prevent postpartum weight retention. With systematic reviews of
dietary clinical trials showing that dietary interventions in pregnancy resulted in reduction
in maternal gestational weight gain and improved pregnancy outcomes. Furthermore, current
clinical guidelines in the UK advocate a healthy weight before pregnancy, a healthy diet and
being physically active, returning to a healthy weight post pregnancy with healthy eating
guidelines provided. Midwives are also recommended and ideally placed to provide healthy
eating, weight management and physical activity support to help women eat well and manage
their weight during pregnancy and beyond.
Studies evaluating healthy eating adherence in pregnancy show that although a majority of
pregnant women in the studies believed that their diet was healthy, just a fraction of them
met the recommended dietary intake for all the food groups in pregnancy. There is very little
known about the uptake of healthy eating messages/interventions and adherence to healthy
eating guidelines in pregnancy amongst pregnant African migrant women living in the UK.
Considering also that the healthy eating guideline is made to suit the cultural preferences
of the host nation, it is imperative that dietary interventions and/or healthy eating
messages targeted at this group are conducted. Following a review of literature, and
discussions with practitioners, there has been no known dietary intervention in pregnancy in
the UK particularly targeting pregnant migrant African women.
Evidence from systematic reviews and meta-analysis suggests that culturally adapted health
interventions are effective in ethnic minority population, including those targeted at
smoking cessation, physical activity and healthy diet. Health is also said to be influenced
by culture-linked behaviours. Such behaviours are transmitted from elders to children and
continue through generations which are evident in patterns of food selection, food
preparation and mental constructions of body shape, size, functions and disease processes.
Cultural adaptation involves a consideration of language, culture and context in an
intervention such that it suits cultural patterns, meanings and values of the target
population.The need for cultural adaptation of healthy eating messages for pregnant Africans
is further buttressed by the fact that dietary behaviours of pregnant Africans post migration
are not completely changed from traditional dietary practices.
Despite the need for interventions to promote healthy eating in pregnancy amongst pregnant
African migrant women in the UK, very little is known about the perceptions of these women
around healthy eating, factors that influence healthy eating (barriers and facilitators) and
the perception of midwives regarding the provision of healthy eating advice to this
population. Qualitative evidence that has considered perceptions of pregnant African women
living in high income countries exist mainly in the United States and is centred on
sociocultural influences regarding body size, misunderstanding about what is considered as
healthy, cravings and palatability, and the belief that gaining weight indicate healthy
babies.
Also qualitative studies evaluating the experiences of midwives and other healthcare
providers in providing healthy eating advice to pregnant women show that although healthy
eating advice was offered in pregnancy, it was not regarded as a priority. Barriers for the
midwives existed in terms of topic sensitivity, inadequate training and cultural differences.
Considering that qualitative evidence is context specific and might not be generalizable, it
is important to explore the barriers and facilitators to healthy eating amongst pregnant
African migrant women as peculiar to the United Kingdom. It is also important to explore
midwives perspectives concerning the provision of healthy eating advice to this population.
This study is a formative research. Formative researches are used to determine how well an
intervention would fit the needs and preferences of a group. It follows the social
constructivist relativist point of view and the Medical Research Council (MRC) framework for
the development and evaluation of complex interventions. The social constructivist
epistemology emphasises that our reality is socially constructed based on human perception,
experience, opinions, beliefs and the context of their lives and knowledge is dependent on
the environment in which we live. Culture and context is emphasized with regards to
understanding what occurs in the society and constructing knowledge around it. This study
will attempt to understand the perception towards healthy eating by pregnant African migrant
women based on their socially constructed reality within their culture and the context of
living in the United Kingdom.
The MRC framework emphasizes the need to interview potential recipients of an intervention
and the stakeholders with the view to identify and develop appropriate theory and increase
acceptability of the intervention. Qualitative interviewing will be used to explore the
concept of perceived barriers and facilitators to healthy eating during pregnancy among
pregnant African migrant women living in the UK and the perception of midwives to providing
healthy eating advice to pregnant African migrant women. It is hoped that evidence from this
study will be used to develop a culturally adapted healthy eating intervention framework for
migrant African women in the UK.
Aim To explore perceived barriers and facilitators to healthy eating amongst pregnant African
migrant women in the UK and midwives perception of providing healthy eating advice to this
population.
Objectives
- To determine how healthy eating is interpreted and understood by pregnant African
migrant women living in the UK
- To identify the factors considered significant (barriers and facilitators) to healthy
eating in this population
- To identify cultural factors considered significant to the uptake of healthy eating
messages in this population
- To explore the current sources of nutrition information in pregnancy for African
migrants living in the UK.
- To explore midwives perspectives on providing healthy eating advice to pregnant African
migrants.
