Process evaluation methods and results from the Health in Pregnancy and Postpartum (HIPP) randomized controlled trial

Sara Wilcox, Alicia A Dahl, Alycia K Boutté, Jihong Liu, Kelsey Day, Gabrielle Turner-McGrievy, Ellen Wingard, Sara Wilcox, Alicia A Dahl, Alycia K Boutté, Jihong Liu, Kelsey Day, Gabrielle Turner-McGrievy, Ellen Wingard

Abstract

Background: Excessive gestational weight gain has increased over time and is resistant to intervention, especially in women living with overweight or obesity. This study described the process evaluation methods and findings from a behavioral lifestyle intervention for African American and white women living with overweight and obesity that spanned pregnancy (≤ 16 weeks gestation) through 6 months postpartum.

Methods: The Health in Pregnancy and Postpartum (HIPP) study tested a theory-based behavioral intervention (vs. standard care) to help women (N = 219; 44% African American, 29.1 ± 4.8 years) living with overweight or obesity meet weight gain guidelines in pregnancy and lose weight in postpartum. Participants completed process evaluation surveys at 32 weeks gestation (n = 183) and 6 months postpartum (n = 168) regarding their perceptions of most and least helpful aspects of the intervention. A database tracked delivery and receipt of intervention components (in-depth counseling session, telephone calls, podcasts). Descriptive statistics are used to report fidelity, dose, and participants' perceptions. We also tested whether dose of behavioral intervention components was associated with gestational weight gain and 6-month postpartum weight retention with linear regression models controlling for baseline age and gestational weeks, receipt of Medicaid, race, parity, and marital status. A content analysis was used to code and analyze responses to open-ended survey questions.

Results: Over 90% of participants (both groups) would recommend the program to a friend. Implementation fidelity was moderately high and greater in pregnancy than postpartum for all intervention components. Dose received and participants' ratings of the in-depth counseling session and telephone calls were more favorable than podcasts. The Facebook group was not perceived to be very helpful, likely because of low participant interaction. Although podcasts were created to reinforce call topics, this redundancy was viewed negatively by some. More calls completed and more podcasts downloaded related to lower gestational weight gain (p < .05).

Conclusion: Study findings underscore challenges in engaging this important but busy population, especially during the postpartum period.

Trial registration: The study was registered at clinicaltrials.gov (NCT02260518) on 10/09/2014. https://ichgcp.net/clinical-trials-registry/NCT02260518 .

Keywords: Behavioral intervention; Implementation; Nutrition; Physical activity; Postpartum; Pregnancy; Process evaluation; Weight; Women.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

References

    1. Stang J, Huffman LG. Position of the Academy of Nutrition and Dietetics: Obesity, reproduction, and pregnancy outcomes. J Acad Nutr Diet. 2016;116(4):677–91. doi: 10.1016/j.jand.2016.01.008.
    1. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No 763: Ethical considerations for the care of patients with obesity. Obstet Gynecol. 2019;133(1):e90-e6.
    1. American College of Obstetricians and Gynecologists Physical activity and exercise during pregnancy and the postpartum period: ACOG committee opinion, number 804. Obstet Gynecol. 2020;135(4):e178-e88.
    1. Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114(7):1099–103. doi: 10.1016/j.jand.2014.05.005.
    1. Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines: National Academy of Sciences; 2009 [updated May. Available from: . Accessed December 12, 2021.
    1. Gaston A, Cramp A. Exercise during pregnancy: a review of patterns and determinants. J Sci Med Sport. 2011;14(4):299–305. doi: 10.1016/j.jsams.2011.02.006.
    1. Hillier SE, Olander EK. Women’s dietary changes before and during pregnancy: A systematic review. Midwifery. 2017;49:19–31. doi: 10.1016/j.midw.2017.01.014.
    1. Deputy NP, Sharma AJ, Kim SY, et al. Prevalence and characteristics associated with gestational weight gain adequacy. Obstet Gynecol. 2015;125(4):773–81. doi: 10.1097/AOG.0000000000000739.
    1. Teede HJ, Bailey C, Moran LJ, et al. Association of antenatal diet and physical activity-based interventions with gestational weight gain and pregnancy outcomes: A systematic review and meta-analysis. JAMA Intern Med. 2022;182(2):106–14. doi: 10.1001/jamainternmed.2021.6373.
    1. Cantor AG, Jungbauer RM, McDonagh M, et al. Counseling and behavioral interventions for healthy weight and weight gain in pregnancy: Evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;325(20):2094–109. doi: 10.1001/jama.2021.4230.
    1. Flannery C, Fredrix M, Olander EK, et al. Effectiveness of physical activity interventions for overweight and obesity during pregnancy: a systematic review of the content of behaviour change interventions. Int J Behav Nutr Phys Act. 2019;16(1):97. doi: 10.1186/s12966-019-0859-5.
    1. Shieh C, Cullen DL, Pike C, et al. Intervention strategies for preventing excessive gestational weight gain: systematic review and meta-analysis. Obes Rev. 2018;19(8):1093–109. doi: 10.1111/obr.12691.
    1. Wilcox S, Liu J, Addy CL, et al. A randomized controlled trial to prevent excessive gestational weight gain and promote postpartum weight loss in overweight and obese women: Health In Pregnancy and Postpartum (HIPP) Contemp Clin Trials. 2018;66:51–63. doi: 10.1016/j.cct.2018.01.008.
    1. Liu J, Wilcox S, Wingard E, et al. Strategies and challenges in recruiting pregnant women with elevated body mass index for a behavioral lifestyle intervention. Womens Health Rep. 2020;1(1):556–65.
    1. Liu J, Wilcox S, Wingard E, et al. A behavioral lifestyle intervention to limit gestational weight gain in pregnant women with overweight and obesity. Obes (Silver Spring) 2021;29(4):672–80. doi: 10.1002/oby.23119.
    1. Liu J, Wilcox S, Hutto B, et al. Effects of a lifestyle intervention on postpartum weight retention among women with elevated weight. Obes (Silver Spring) 2022;30(7):1370–9. doi: 10.1002/oby.23449.
    1. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;650(6):e135-42.
    1. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report Washington, DC: U.S. Department of Health and Human Services; 2018 [Available from: . Accessed June 20, 2021.
    1. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans 2008 [Available from: . Accessed June 9, 2022.
    1. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986. p. 617.
    1. Coll CV, Domingues MR, Goncalves H, et al. Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence. J Sci Med Sport. 2017;20(1):17–25. doi: 10.1016/j.jsams.2016.06.007.
    1. Evenson KR, Moos MK, Carrier K, et al. Perceived barriers to physical activity among pregnant women. Matern Child Health J 2008.
    1. Liu J, Wilcox S, Whitaker K, et al. Preventing excessive weight gain during pregnancy and promoting postpartum weight loss: a pilot lifestyle intervention for overweight and obese African American women. Matern Child Health J. 2015;19(4):840–9. doi: 10.1007/s10995-014-1582-0.
    1. Goodrich K, Cregger M, Wilcox S, et al. A qualitative study of factors affecting pregnancy weight gain in African American women. Matern Child Health J. 2013;17(3):432–40. doi: 10.1007/s10995-012-1011-1.
    1. Turner-McGrievy GM, Campbell MK, Tate DF, et al. Pounds Off Digitally study: a randomized podcasting weight-loss intervention. Am J Prev Med. 2009;37(4):263–9. doi: 10.1016/j.amepre.2009.06.010.
    1. National Diabetes Prevention Program. Curricula and Handouts [updated August 25. 2020. Available from: . Accessed September 11, 2020.
    1. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. doi: 10.1177/1049732305276687.
    1. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398–405. doi: 10.1111/nhs.12048.
    1. Eakin EG, Lawler SP, Vandelanotte C, et al. Telephone interventions for physical activity and dietary behavior change: a systematic review. Am J Prev Med. 2007;32(5):419–34. doi: 10.1016/j.amepre.2007.01.004.
    1. Goode AD, Reeves MM, Eakin EG. Telephone-delivered interventions for physical activity and dietary behavior change an updated systematic review. Am J Prev Med. 2012;42(1):81–8. doi: 10.1016/j.amepre.2011.08.025.
    1. Symons Downs D, Savage JS, Rivera DE, et al. Individually tailored, adaptive intervention to manage gestational weight gain: Protocol for a randomized controlled trial in women With overweight and obesity. JMIR Res Protoc. 2018;7(6):e150-e. doi: 10.2196/resprot.9220.
    1. King AC, Friedman R, Marcus B, et al. Ongoing physical activity advice by humans versus computers: the Community Health Advice by Telephone (CHAT) trial. Health Psychol. 2007;26(6):718–27. doi: 10.1037/0278-6133.26.6.718.
    1. Babu GR, Karthik M, Ravi D, et al. What makes the pregnant women revisit public hospitals for research? Participant engagement and retention trial in a public hospital (PERTH): an RCT protocol. BMC Pregnancy Childbirth. 2018;18(1):369. doi: 10.1186/s12884-018-2000-1.
    1. Posadzki P, Mastellos N, Ryan R, et al. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev. 2016;12(12):Cd009921.
    1. Pew Research Center. Social media fact sheet - Social media use over time 2019 [Available from: . Accessed October 6, 2020.
    1. Hales S, Davidson C, Turner-McGrievy G. Varying social media post types differentially impacts engagement in a behavioral weight loss intervention. Translational Behav Med. 2014;4(4):1–8. doi: 10.1007/s13142-014-0274-z.
    1. Turner-McGrievy GM, Davidson CR, Wingard EE, et al. Low glycemic index vegan or low-calorie weight loss diets for women with polycystic ovary syndrome: a randomized controlled feasibility study. Nutr Res. 2014;34(6):552–8. doi: 10.1016/j.nutres.2014.04.011.
    1. Silfee VJ, Lopez-Cepero A, Lemon SC, et al. Adapting a behavioral weight loss intervention for delivery via Facebook: A pilot series among low-income postpartum women. JMIR Formativ Res. 2018;2(2):e18. doi: 10.2196/formative.9597.
    1. Vander Wyst KB, Vercelli ME, O’Brien KO, et al. A social media intervention to improve nutrition knowledge and behaviors of low income, pregnant adolescents and adult women. PLoS ONE. 2019;14(10):e0223120. doi: 10.1371/journal.pone.0223120.
    1. Waring ME, Moore Simas TA, Oleski J, et al. Feasibility and acceptability of delivering a postpartum weight loss intervention via Facebook: A pilot study. J Nutr Educ Behav. 2018;50(1):70–4.e1. doi: 10.1016/j.jneb.2017.09.025.
    1. Baruth M, Schlaff RA, Deere S, et al. The feasibility and efficacy of a behavioral intervention to promote appropriate gestational weight gain. Matern Child Health J. 2019;23(12):1604–12. doi: 10.1007/s10995-019-02812-6.
    1. Mann S, Carter MC. Emotional disclosures and reciprocal support: The effect of account type and anonymity on supportive communication over the largest parenting forum on Reddit. Hum Behav Emerg Technol. 2021;3(5):668–76. doi: 10.1002/hbe2.284.
    1. van Uden-Kraan CF, Drossaert CHC, Taal E, et al. Self-reported differences in empowerment between lurkers and posters in online patient support groups. J Med Internet Res. 2008;10(2):e18. doi: 10.2196/jmir.992.
    1. Aronson ID, Marsch LA, Acosta MC. Using findings in multimedia learning to inform technology-based behavioral health interventions. Transl Behav Med. 2012;3(3):234–43. doi: 10.1007/s13142-012-0137-4.

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