Date of Award

2018

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

Sub-Department

The Norman J. Arnold School of Public Health

First Advisor

Gabrielle Turner-McGrievy

Abstract

INTRODUCTION: Almost one-half of all pregnant women in the U.S. exceed the Institute of Medicine’s (IOM) gestational weight gain (GWG) guidelines. Healthy GWG is critical for reducing adverse health outcomes associated with excessive GWG for the mother and infant. Electronic health (e-health) interventions delivered through mobile apps and websites hold potential as readily available resources for targeting health behaviors and monitoring GWG during pregnancy. The development of the Healthy Motivations for Moms-To-Be (HM2B) intervention was informed by health behavior theories, a systematic review of existing in-person and technology mediated interventions (Aim 1 of this dissertation), and results of an online needs assessment (Aim 2) of pregnant women’s weight-related knowledge, behaviors, interests in various e-health intervention components. Participants were randomized to receive one of two intervention conditions (Aim 3). Participants in the Healthy Eating and Physical Activity (HEPA) condition received targeted GWG goals (based on pre-pregnancy Body Mass Index (BMI)), as well as evidence-based behavioral strategies to encourage healthy GWG, while the comparison condition received content related to Stress Reduction and Management (SRAM) techniques to reduce overall stress levels during pregnancy. Participants used a study website to track individual health behaviors and outcomes respective of their study conditions, access informational podcasts, and read weekly tips for having a healthy pregnancy. The website was developed by the TecHealth Center. In addition, participants were assigned to a group of 8-10 other pregnant women and virtually connected through a commercially-available free mobile app called MakeMe, for 12 consecutive weeks. Each week, participants were provided a behavioral goal to aim for on 5 of the 7 days during the week. Social support elements (i.e., comments and “thumbs up” to teammates’ activity) were included in the mobile app to encourage participation, social support, and maintenance of the behavioral goal. The purpose of this study was determine the impact of a mobile health intervention, Healthy Motivations for Moms-To-Be (HM2B), targeting healthy eating and physical activity (HEPA) on GWG and increase the proportion of women who gain within the Institute of Medicine’s (IOM) guidelines for healthy gestational weight gain (GWG).

METHODS: Healthy pregnant women (N=140) living in the U.S. were recruited through social media to participate in a randomized controlled electronic health intervention, which consisted of a mobile app for facilitating group-based healthy behavior challenges and a website for tracking health outcomes (i.e., GWG). The intervention condition targeted HEPA behaviors during pregnancy, while the comparison condition focused on stress reduction and management during pregnancy. Pre-pregnancy weight and weight at delivery were self-reported to determine GWG in relation to IOM guidelines. Participants completed online surveys at baseline (<20 weeks) and upon completion of the 12 week group-based intervention. Surveys included the Rapid Eating Assessment for Participants-Shortened (REAP-S) scale for measuring typical dietary intake.

RESULTS: Participants who completed their delivery outcomes survey were included in the analysis (n=87). The sample was predominately white (81.6%) and highly educated (advanced degree beyond Bachelor’s; 58.6%). Regarding adherence to IOM guidelines, there was a promising but not significant difference in the proportion of women gaining adequate weight in the intervention versus comparison group (36% vs. 25%) or in the proportion of women who exceeded IOM guidelines (43% vs. 53%, respectively, p=0.42). There was a significant difference observed in post-intervention healthy eating behaviors reported between groups (F (1,87)=4.07, p=0.047), where HEPA participants reported healthier eating scores on the Rapid Eating Assessment for Participants (REAP) scale.

CONCLUSIONS: Although the effect of the intervention on reducing excessive GWG was not significant, the HM2B study demonstrated potential in facilitating healthy behavior change through group-based goal setting and self-monitoring using a mobile app. Future studies should explore opportunities for increasing user engagement and interaction for sustained use of eHealth interventions.

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