The Effectiveness of Client-Centered Conversations to Promote Healthy Diets, Physical Activity, and Guideline Concordant Gestational Weight Gain in Pregnant Mothers: A Pragmatic Randomized Controlled Trial

Abstract

Background: To promote healthy gestational weight gain, the Institute of Medicine (IOM) recommends healthcare providers regularly weigh every pregnant woman, and follow with a discussion about gestational weight gain recommendations and healthy lifestyles. Research suggests that healthcare providers consider gestational weight gain to be important yet may not regularly discuss it with women for reasons including: lack of time, uncertainty with how to approach the discussion, fear of losing trust or rapport with the woman, and other systematic and individual-level barriers. Healthy Conversation Skills (HCS), a communication technique, was trialed by a Registered Dietitian (RD), as a means to open a discussion about gestational weight gain and determinants. Healthcare providers trained in HCS aim to support individuals towards healthy behaviour change by utilizing three key communication skills– asking open discovery questions, listening, and supporting goal setting. The purpose of this study was to: (a) pilot the communication technique, Healthy Conversation Skills, to assist women in adopting and maintaining healthy lifestyle behaviours and weight gain in concordance with national gestational weight gain guidelines and (b) to evaluate the impact of use of the Healthy Conversation Skills approach on total gestational weight gain, women’s lifestyle behaviours, and women’s study perceptions. Methods: Seventy low-risk pregnant women were randomized to an active control (AC) or intervention (INT) group and interacted with their respective RD for two visits and two phone calls. Both RD’s administered lifestyle questionnaires and the INT RD created opportunities to discuss healthy behavior changes using HCS throughout the visits, while the AC RD did not. Women also completed a third lifestyle questionnaire via email at 34 weeks. Postpartum, women answered a questionnaire about their perceptions of their prenatal experience. A passive control group (PC) of women ≤12 months postpartum (n=55) was recruited to only complete the postpartum questionnaire. This group models standard prenatal care in Alberta (no RD visits in pregnancy). Gestational weight gain data was collected from obstetrical charts and adherence to gestational weight gain recommendations was defined in accordance with IOM guidelines. Results: Pre-pregnancy BMI, ethnicity, education, marital status, household income and parity did not differ between INT (n=33), AC (n=37), and PC (n=55) groups. Total GWG, rate of weight gain and adherence to GWG guidelines did not differ between the three study groups. Between visit 1 (mean gestational age: 16.2±3.8) and visit 2 (mean gestational age: 29.3±1.2 weeks), INT women increased their diet quality score (28.9 ± 7.7 to 34.2 ± 7.2, p=0.0012), while the AC group did not (35.1 ± 9.0 to 36.2 ± 9.4, p=0.5370). At 34.4(0.86) weeks AC women reported being sedentary for 3 MET-hours/week more than INT women (p=0.0073). Postpartum, INT women were more likely to strongly agree that participating in the study “improved at least 1 of my lifestyle habits” compared to AC women (p=0.009). INT women were more likely to strongly agree that participating in the study “was beneficial” (p=0.070) compared with AC women, although the difference bordered on significance. INT women also were more likely to agree or strongly agree that their study RD “asked about things important to me” (p=0.056). Although non-significant, a trend towards significance was found for the INT group more strongly agreeing their participation was beneficial (p=0.070) and their “study RD was interested in them and how the pregnancy was affecting their life” (p=0.077) compared to the AC group. Conclusion: When a RD initiates a conversation about healthy lifestyles in pregnancy, women report positive outcomes in behaviours related to dietary intake and physical activity. The change in lifestyle behaviours and the higher sense of support from the RD that was reported from the INT group demonstrates the potential use of HCS to approach, initiate, and continue discussions surrounding healthy lifestyles. Future research is required to determine the effectiveness of Healthy Conversation Skills.