Barriers To Weight-Related Health Behaviors: A Qualitative Comparison Of The Socio-Ecological Conditions Between Pregnant And Postpartum Low-Income Women

Abstract

The association between socio-ecological factors and poor health outcomes for the low-income women and their children has been the focus of disparities research for several decades. Comparative qualitative studies have examined issues such as mood, body image, smoking and breastfeeding in both pregnant and postpartum women. This research identifies and compares the changing socio-ecological conditions among lowincome women from pregnancy to postpartum and highlights the multitude of factors that may make women's lives increasingly difficult after delivery. This research may inform public health nutrition programs, such as Supplemental Food and Nutrition Program for Women, Infants and Children (WIC) program or Supplemental Nutrition Assistance Program (SNAP), as well as interventions that promote behavior change in low-income women during the pregnancy and postpartum periods. As part of formative research for developing an online health intervention for pregnant and postpartum women between the ages of 18-35, group and individual interviews were conducted with pregnant and postpartum women who qualified for either WIC or PCAP (Prenatal Care Assistance Program). Five pregnancy group interviews (n=15 women, ranging from 2-5 women per group), five postpartum group interviews (n=23 women, ranging from 3-6 women per group) and seven individual interviews with a total of 45 participants were conducted in Rochester, NY. Group and individual interviews explored the influences on healthy behaviors including diet and physical activity during pregnancy and postpartum; experiences, strategies and barriers to change behavior; and the role of social support in supporting/discouraging healthy behaviors. All group and individual interviews were audio-recorded. Detailed notes were taken and added in subsequent listening to the recordings. The constant comparative method was used to code group and individual interview notes and to identify emergent themes. All of the women in the sample faced a great number of challenges that impacted their attitudes and beliefs, as well as, their ability to maintain or improve healthy behaviors. Such challenges included unemployment, relationship issues, minimal social support, lack of education, healthcare access, preexisting medical conditions and neighborhood disadvantage, including a poor food environment and criminal activity. Compared to pregnant women, postpartum women faced additional difficulties, such as child illnesses, child custody issues and homelessness. Many factors contribute to women's difficulties postpartum, including challenges that are present prior to delivery, those present prior to delivery that worsen after delivery, and some new challenges that begin after delivery. The most striking differences between weight-related barriers during pregnancy and postpartum related to the family's medical issues and to greater environmental constraints.!The socio-demographic constraints that low-income women face after delivery and the impact those constraints have on their ability to change health behaviors are critical to consider when designing health promotion interventions.!