Excessive gestational weight gain: Assessing patients' and providers' perceptions.

OBJECTIVE

To assess counseling practices for gestational weight gain (GWG) among primary care providers (PCPs) at 2 clinics to identify barriers and potential health interventions for patients from diverse cultural backgrounds.

DESIGN

Qualitative interviews with data analyzed for emerging themes using a modified grounded theory method.

SETTING

Interviews at the South East Toronto Family Health Team and Flemingdon Health Centre in Toronto, Ont, from September 2016 to February 2018.

PARTICIPANTS

Family practice obstetric providers and pregnant patients.

METHODS

Semistructured interviews and focus groups were audiorecorded and transcribed. Analysis used a constant comparative approach to identify themes.

MAIN FINDINGS

Patients had a limited understanding of risks associated with excessive GWG and reported infrequent weight counseling by PCPs. Patients at the South East Toronto Family Health Team had high health literacy and were proactive in seeking health information but had difficulty navigating reliable resources. Patients at Flemingdon Health Centre had lower health literacy and more passive interactions with PCPs, relying on family advice and cultural practices to inform health behaviour. Barriers for this group included social isolation and limited funds. Both groups desired increased proactive health counseling and resources. Physicians were knowledgeable about excessive GWG and reported counseling their patients, although patient retention and limited time were barriers.

CONCLUSION

Healthy lifestyle in pregnancy is an important but underemphasized topic in antenatal care owing to barriers faced by patients and physicians, with unique socioeconomic considerations. This gap provides an opportunity to increase education of patients and providers and to develop patient-centred weight management interventions. By contrasting patient groups, our study reflected the importance of addressing social determinants of health in comprehensive care.