School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia.
Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, P.O. Box 378, Jimma, Ethiopia.
Nutr J. 2020 Apr 28;19(1):38. doi: 10.1186/s12937-020-00536-w.
Undernutrition during pregnancy affects birth outcomes adversely. In Ethiopia, despite nutrition counseling on the maternal diet being given by the health workers during pregnancy, maternal undernutrition is still high in the country. Hence, this study aimed to assess the effect of guided counseling using the health belief model and the theory of planned behavior on the nutritional status of pregnant women.
A two-arm parallel cluster randomized controlled community trial was conducted in West Gojjam Zone, Ethiopia, from May 1, 2018, to April 30, 2019. The nutritional status of the women was assessed using mid-upper arm circumference. A total of 694 pregnant women were recruited from the intervention (n=346 ) and control (n=348) clusters. Of which endline data were collected from 313 and 332 pregnant women in the intervention and control clusters, respectively. The intervention was started before 16 weeks of gestation and pregnant women in the intervention group attended 4 counseling sessions. Counseling was given at the participants' homes using a counseling guide with the core contents of the intervention. Leaflets with appropriate pictures and the core messages were given for women in the intervention arm. Women in the control group got the routine nutrition education given by the health care system. Data were collected using interviewer administered structured questionnaires and mid-upper arm circumference was measured using an adult MUAC tape. Descriptive statistics and linear mixed-effects model were used to assess the intervention effect after adjusting for potential confounders.
After the intervention, the prevalence of undernutrition was 16.7% lower in the intervention group compared with the control arm (30.6% Vs 47.3%, P = < 0.001). Women in the intervention group showed significant improvement in nutritional status at the end of the trial than the control group (β = 0.615, p = < 0.001).
This study demonstrated that guided counseling using the health belief model and the theory of planned behavior was effective in improving the nutritional status of pregnant women. The results imply the need for the design of model and theory based nutrition counseling guidelines. The trial was registered in Clinical Trials.gov (NCT03627156).
孕期营养不良会对分娩结果产生不利影响。在埃塞俄比亚，尽管卫生工作者在孕期对产妇饮食进行了营养咨询，但该国仍存在较高的产妇营养不良问题。因此，本研究旨在评估使用健康信念模型和计划行为理论对孕妇营养状况的指导咨询效果。
这是一项在埃塞俄比亚西戈贾姆地区进行的、为期两年的平行群组随机对照社区试验，从 2018 年 5 月 1 日至 2019 年 4 月 30 日进行。采用中上臂周径评估妇女的营养状况。共招募了 694 名来自干预组（n=346）和对照组（n=348）的孕妇。其中，干预组和对照组分别有 313 名和 332 名孕妇在最后线收集数据。干预措施在妊娠 16 周前开始，干预组的孕妇参加了 4 次咨询。在参与者家中，使用带有干预核心内容的咨询指南进行咨询。干预组的孕妇还获得了带有适当图片和核心信息的传单。对照组的孕妇接受了卫生保健系统提供的常规营养教育。使用访谈者管理的结构化问卷收集数据，并使用成人 MUAC 带测量中上臂周径。采用描述性统计和线性混合效应模型，在调整潜在混杂因素后评估干预效果。
干预后，干预组的营养不良患病率较对照组低 16.7%（30.6% vs 47.3%，P<0.001）。与对照组相比，干预组妇女在试验结束时的营养状况有显著改善（β=0.615，p<0.001）。
本研究表明，使用健康信念模型和计划行为理论的指导咨询可有效改善孕妇的营养状况。结果表明需要设计基于模型和理论的营养咨询指南。该试验已在 ClinicalTrials.gov（NCT03627156）注册。
