Empowerment of pregnant women to have a healthier dietary intake. The development, implementation and evaluation of an integral strategy

The overall goal of this research project is to improve the dietary intake of low socioeconomic status (SES) pregnant women. This project aims to develop, implement and evaluate an integral strategy that empowers low SES pregnant women to have a healthier dietary intake. This is relevant for both society and science, as maternal nutrition is crucial for optimal foetal development and population health. Pregnant women are receptive to changing dietary intake during pregnancy. Midwives acknowledge their potential role in promoting healthier dietary intake, but lack time and specific knowledge and skills for an integral strategy tailored to the needs of low SES pregnant women, their everyday life, family situation, and physical and social environment. Moreover, there is currently no integral strategy fitting concurrent antenatal care that focuses on empowering pregnant women to have a healthier dietary intake. In this project, such an integral strategy will be developed, implemented and evaluated jointly with all stakeholders, including pregnant women and their partners.

The three research questions are:
1. What are low SES pregnant women’s perceptions of a healthy dietary intake and what factors contribute to empowering them to have a healthy dietary intake?
2. What is needed in the multidisciplinary collaboration between midwives and other (health) professionals to implement a strategy that empowers low SES pregnant women to have a healthy dietary intake?
3. What is the impact of the developed strategy on low SES pregnant women’s empowerment, dietary intake and pregnancy-related outcomes?

The research questions will be answered by mixed methods, i.e. literature research, in-depth interviews, observations, questionnaires and data obtained from physical examinations by midwives. Participation of stakeholders is put centre core: 10 expert meetings with pregnant women and their partners and 6 expert meetings with midwives and other (health) professionals and experts will be organised to discuss recruitment methods, research activities and the strategy. In the first two years, the strategy will be developed based on input from stakeholders, including pregnant women and their partners, in order to take into account what is important to them, e.g. their social environment and financial situation. This means that neither the strategy’s content/form nor research methods can be described in detail in advance, e.g. extra individual consultations or extra group (e.g. CenteringPregnancy: CPr) meetings. The strategy will be implemented as a pilot and evaluated as a multiple case study in the third and fourth year. The pilot will entail 5–10 midwives implementing the strategy with 50–100 low SES pregnant women. To evaluate the strategy, a ‘one-group pre-test/post-test’ design will be used, and the barriers and success factors for implementing the strategy will be monitored.

The research will be guided by the socioecological model of health to include different influences on empowerment and dietary intake on multiple levels. The Behaviour Change Wheel (BCW) will be used to conceptualise and assess empowerment. The Healthy Alliances (HALL) framework will be used to unravel the factors in the multidisciplinary collaboration relevant to the implementation of the strategy.

The project partners and researchers are confident of conducting a successful project. Factors contributing to feasibility are 1) a multidisciplinary project group including key stakeholders from practice and science; 2) strong stakeholder participation, including pregnant women and their partners; 3) a flexible recruitment protocol with sufficient time and budget; 4) the usage of existing networks, activities and data; 5) the integration of a tool to assess dietary intake developed by the project ‘Why pregnant women eat what they eat’; 6) a large research capacity through the assistance of master’s students; and finally 7) previous experience with similar integral projects and low SES target groups.