Dadouch Rachel, Lalani Sarenna, Windrim Rory, Maxwell Cynthia, Kingdom John, D'Souza Rohan, Parsons Janet
Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2025 Feb 10;20(2):e0318514. doi: 10.1371/journal.pone.0318514. eCollection 2025.
There are numerous biomedical and psychosocial challenges associated with obesity in pregnancy that impede communication between healthcare providers (HCPs) and patients. We conducted a narrative study informed by stigma theory to understand specific areas of communication breakdown in obesity-in-pregnancy clinical encounters. Sixteen patients and 19 HCPs participated in in-depth, semi-structured interviews. We explored how participants positioned obesity-in-pregnancy clinical encounters within their broader narratives. Employing narrative analysis, we identified five narrative tensions contributing to communication challenges: 1) obesity as a detriment to health versus an acceptable biologic variation; 2) obesity as the result of personal choice versus the result of uncontrollable circumstances; 3) a regular pregnancy versus a high-risk diagnosis; 4) a typical and problem-free clinical encounter versus a tremendously difficult clinical encounter; and 5) talking openly about Body Mass Index (BMI) and related co-morbidities versus sidestepping the topic. How participants positioned themselves relative to prevailing societal discourses regarding obesity in general influenced these tensions. These narrative tensions revealed specific areas where communication is vulnerable to breaking down during the obesity-in-pregnancy clinical encounter. Participants' (both HCPs and patients) past experiences of clinical encounters-and the meanings they ascribe to them-shape subsequent encounters, and our analysis illuminates the complexities of this interactive space. This research has implications for improving clinical practice and education.
孕期肥胖存在众多生物医学和社会心理方面的挑战，这些挑战阻碍了医疗服务提供者（HCPs）与患者之间的沟通。我们开展了一项以污名理论为依据的叙事研究，以了解孕期肥胖临床诊疗过程中沟通出现问题的具体领域。16名患者和19名医疗服务提供者参与了深入的半结构化访谈。我们探讨了参与者如何将孕期肥胖临床诊疗过程置于其更广泛的叙述之中。通过叙事分析，我们确定了导致沟通挑战的五种叙事张力：1）肥胖对健康有害与可接受的生物学变异；2）肥胖是个人选择的结果与不可控情况的结果；3）正常妊娠与高危诊断；4）典型且无问题的临床诊疗过程与极其困难的临床诊疗过程；5）公开谈论体重指数（BMI）及相关合并症与回避该话题。参与者如何将自己置于关于肥胖的主流社会话语之中，总体上影响了这些张力。这些叙事张力揭示了孕期肥胖临床诊疗过程中沟通容易出现问题的具体领域。参与者（医疗服务提供者和患者）过去的临床诊疗经历以及他们赋予这些经历的意义塑造了后续的诊疗过程，我们的分析阐明了这个互动空间的复杂性。这项研究对改善临床实践和教育具有启示意义。
