GDM: Physical Activity (2008)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
To investigate the influence of social support on weight, diet and physical activity-related beliefs and behaviors among pregnant and postpartum Latinas.
Inclusion Criteria:
  • Spanish speaking Latino pregnant and postpartum community residents
  • At least 18 years of age
Exclusion Criteria:
Not described.
Description of Study Protocol:

Recruitment Spanish speaking Latino pregnant and postpartum community residents who were at least 18 years of age were recruited by flyers and in person by trained female recruiters at a federally qualified health center, a Special Supplemental WIC Program, and a "Baby Fair" run by community organization partners. 

Pregnant women were recruited at any point during pregnancy, and postpartum women were recruited at approximately 6-12 weeks following delivery.  During the initial eligibility assessment, women identified a person whom they believed influenced their dietary and physical activity practices.   The recruiter later contacted both the participant and the influential persons by telephone to confirm their interest in participating and to schedule interviews.

Design:  Noncomparative Descriptive Study

Blinding used (if applicable) Not described

Intervention (if applicable) Five pregnant and five post-partum women and 10 people identified by the women as most likely to influence their beliefs and practices.  All interviews were conducted in Spanish.  The same person interviewed a dyad to facilitate exploring variations in perceptions expressed in the 2 interviews.  Interviews with the pregnant and postpartum women were conducted first.  Their interviews were conducted in locations where they were most comfortable and where confidentiality could be ensured (ie, homes, restaurants, etc). 

Interviews with influential persons were conducted in public places to ensure confidentiality and increase rapport.  No information from the women's interviews was shared with their influential persons or vice versa.  All interviews were audio tape-recorded, transcribed verbatim in Spanish, translated into English, and reviewed for accuracy.

Statistical Analysis Data within and across categories were reviewed to construct social support themes and identify characteristic patterns in social support and health-related beliefs and behaviors based on meanings that emerged from the data.  Results were then analyzed by dyad and summarized by type of participant, ie pregnant, postpartum women or influential person.

 

Data Collection Summary:

Timing of Measurements 5 pregnant and 5 post-partum women were interviewed 

Dependent Variables

  • Weight, diet and physical activity related beliefs and behaviors

Independent Variables 

  • Social support, including husbands, female friends and family

 Control Variables Not applicable

 

Description of Actual Data Sample:

Initial N: 10 Latino dyads; eight dyads were participant-husband pairs and two were female only (one mother and one sister-in-law).

Attrition (final N): 10

Age: 27.1 years (21-36)

Ethnicity: Latino

Other relevant demographics: Mean of 1.5 children, household size 5.1 people (3-10), all married, husbands worked as construction worker, painter or handymen, all born in Mexico.  The pregnant and post-partum women had lived in the US an average of 3.3 years while influential persons had lived in the US an average of 5.2 years.

Anthropometrics Not described.

Location: Southwest Detroit

 

Summary of Results:

Three social support dimensions emerged from the data that influenced participants' weight, diet and physical activity related beliefs:

  • Informational support in these data represented advice, information or guidance
  • Emotional support represented encouragement, criticism or desire to please
  • Instrumental support represented tangible assistance (material, financial or physical)  

The findings suggest that:

  1. Informational and emotional support of husbands were the most important and consistent influence on participants' weight, eating and physical activity practices
  2. Both eating and physical activity patterns were influenced by cultural beliefs and family rituals concerning safe and appropriate foods and physical activities during and after pregnancy
  3. Absence of mothers and female relatives to provide companionship and advice about food was evident
  4. Geographic distance was the primary reason for Latinas being spearated from close female-centered networks, which seemed to interrupt the transmission of health-related beliefs and behaviors 

Other Findings

Social Support on Diet and Eating

Some participants reported eating or buying fewer healthy foods when they experienced financial constraints due to husbands' seasonal work schedules and living with extended families.  During financial distress, fruits and vegetables were typically the first to be sacrificed from food purchases instead of beans, lentils, and particularly meats, because of husbands' preferences.

Despite good intentions, some husbands brought home fattening foods on a regular basis for their wives to enjoy or to satisy their cravings.

Social Support on Physical Activity

During pregnancy and immediately postpartum, they were advised and expected by both husbands and extended family to limit strenuous physical activity.  Lifting heavy objects was strongly discouraged.  Mothers were encouraged generally by other females, not men to rest for at least 1 month postdelivery.

 

 

Author Conclusion:

The informational and emotional support of husbands was the most important and consistent influence on weight, eating, and physical activity practices.  Husbands' concerns and advice about their wives being overweight or "fat" were frequently motivated by a holistic perspective about health whereby physical and mental states were seen as interrelated.  The women valued both these holistic health beliefs and their husbands' opinions.

Both eating and physical activity patterns of study participants were influenced by cultural beliefs concerning safe and appropriate foods, physical activities during and after pregnancy and family rituals.  Women's ability to adopt what they considered healthy eating and exercise habits were mostly affected by the support provided by their husbands.

The lack of other types of tangible support, such as childcare, especially from females, either family or friends, or housekeeping that could free women's time for exercise was a serious barrier to independent activities outside the home or with others.

Some participants reported that low interaction with experienced women limited their knowledge of ways to cook and eat healthy and increased feelings of isolation.

Funding Source:
Reviewer Comments:

This study provides solid preliminary information for future studies and interventions in Latino, and possibly other groups, as to the necessary supports that may be needed to promote optimal pregnancy outcomes with respect to nutrition and physical activity.

No anthropometric data, such as height, weight, BMI, prepregnancy body satisfaction by either the participant or signficant influence, or complications related to the pregnancy, such as gestational diabetes mellitus, were reported.  This information may have impacted the different types of influences women received.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? ???
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? Yes
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? N/A
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? N/A
  7.6. Were other factors accounted for (measured) that could affect outcomes? ???
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? N/A
  8.3. Were statistics reported with levels of significance and/or confidence intervals? N/A
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? N/A
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes